Mautana Azad National Institute 6fTedh
Student details and und€rtakine                   i;i
Name of Scholarship Scheme to be applied & year.......
                Student Name / Branch                                        Scholar No.              Mobile No./re.mail
         Required Document s/ Ptage no.(P)                                    Required Documents            / Page no.(P)
1. Appf ied Scholarship Application Form / p-                       5. Domicile Certificate / P-
2. Tuition /Hostel/otJrer Fee Receipt              /   P-           7. Aadhar Card No.........................../ P-
3. Parents (Father & Motherlfamily Income                           8. Previous year Marksheet(s)/ P-
Certificate Current Yedr I P-
4. Cast Certificate for SC/ST/OBC NCL / p- ,.                       9. JEE Rank lonty    for   First Year)l P-
5. EWS Certificate (if Applicablel        /   p-                    L0. Admission slip ( Only for 1st year students)/ P:
11. Total Number of Sibling (Brother& Sister) applrling for
this Scholarship in Current Year including yourself.
      u.   UNDERTAKING          ( Choose among              Ul or U2 or U3, and mark choosen           one with tick            regi.i
                                                                                                                          "na
 U1    I hereby confirm that I have applied scholarship under scholarship                                        Sign.:
       scheme.....                    .....in the year(s|.......
       but did not receive till date.
 U2    I hereby   confirm that I have neither applied nor received scholarship under                             Sign.:
       any schotarship scheme till date. lf this information is found incorrect or
       false then I would be responsible for the punishment imposed on me by the
       institute.
       I hereby confirm that I have received/ receiving scholarship and the detaits                              Sign.:
       are as follows and proof(s| like amount receipt copy etc. is/are enclosed.
 u3
                              Details af previous year received scholarship
                          Scheme name                                            Year                   Amount received         /   Proot
u3.1
u3.2
u3.3
u3.4
 13    Fathers/ Mother Name           :
       Parent Mobile No.
       Signature of student
The Student presently studying in the year.                                                    and his/her last year
attendance is                             %
Signanture of concerned HOD.
NOTE:- Scholarship application form will be accepted between 3.00 PM to 5.00 PM in the
Scholarship Cell /Academic Section at Estate Building. Please download this form and other
details from wrvw.manit.ac.in