Paste photograph

Annexure- I of the applicant &

(To be Filled by Institution/Student and Dully Certified by Institution) the Photograph to
be attested by the
NOTE: Please fill in the information in capital letters Head of the
1. Registration No.: ………………………………………………………………………… present School/
College/Institute
2. Name of Candidate : ……………………………………………………………………..
3. Date of Birth : …………………………………………………………………….
4. Father’s Name : …………………………………………………………………….
5. Stream: 5a. Persons with Disabilities (PwDs): Yes/No 5 b. Category:……………..
6. Percentage of Marks* (*In case of CGPA/CPI Grade System of marks please convert the same to percentage
system):
th th
a. 10 ………… b. 12 ………… c. Graduation………………(Percentage of all the 3/4 years marks)

7. Name of Present Institute ………………………………………………………………………………………………..

8. Name of the Certificate/Degree Course Presently undergoing ………………………………………………………
9. Total duration of the Course………………………………………………………………………………………………
10. Type of Academic System being followed by the Institute(Annual/Semester type)……………………………….
11. Name of the body approving the present Institute & the course in which the above mentioned Student is
studying (ex: CBSE/ICSE/MCI/AICTE etc.)……………………………………………………………………….........

12. Date of approval by the body as mentioned at Sl. No 11 above …………………………………………………....

13. If OBC, name of OBC caste as per Central Govt. OBC list…………………………State……………………

Date:____/____/________ Signature of the Student

This is to certify that the student has taken admission on ……………(date)………….. (month)………….(Year). ( Only
st th st
in 1 Year of ……………….……………………..(Name of course 11 /1 year of 2 years ITI Course/Engineering
degree/MBBS/MBA) and the information given above is correct as per record of our Institute. Certified that he/she is
not in receipt of any other scholarship/stipend/financial aid from any other source. The institute shall inform IOCL in
case the Student accepts any other scholarship/stipend/financial aid from any other source.

Present Communication Address of Applicant :

………………………………………………………………....

……………………………………………………………….... Signature & name of Head/Dean/Principal of

State………………………………………..Pin……………… School/College/University/Institute with date

Postal Address of School/College/Universities/Institute: Phone No………………………………..…

……………………………………………………………….... Date …………………………………...

………………………………………………………………….

State………………………………………..Pin………………

Seal of School/College/Institute
 Annexure- II

Check List of Documents to be enclosed by the Student along with

Annexure-I (Proforma to be certified by the School/College/Institute)
Sl. Certificates Applicable to Type Attested By
No.
1. Income Certificate All applicants Copy Principal/Head of
(To be issued by the Current School/
Authorised persons as College/Institute
specified in the covering
letter of M/s ACE
Consultants))
2. Date of Birth (as All applicants Copy -do-
mentioned in 10th High
School/Matriculation
certificate)
3. 10th/High School Those applying for Copy -do-
Matriculation Mark Sheet 10+/ITI Scholarship
(indicating overall
percentage or marks)
4. XII / Intermediate Those applying for Copy -do-
Engineering/MBBS/
Scholarship
5. Graduation Mark Sheet Those applying for Copy -do-
(of all years OR Overall MBA Scholarship
Mark Sheet clearly
indicating total overall
percentage)
6. Caste Certificate (to be SC or ST Copy -do-
provided only as per
attached format
Annexure-IV)
7. Class Certificate (to be Only those listed in Copy -do-
provided only as per the Central Govt’s
attached format Annxure- OBC list will be
III) considered against
OBC quota. OBC
candidates of State
list and not covered
by Central Govt’s
OBC list may apply
against general
quota.
8. Persons with Disabilities Applicable only if Copy -do-
(PwDs) minimum 40%
disability as per
definition under
Disabilities Act
1952.
Note: All certificates should be provided ONLY in English/Hindi or a translated true copy in
English/Hindi duly verified and attested by the principal of the current Institute/competent
authority be attached. Photocopy of attested document is not acceptable.

Regards, Administrator
ACE Consultants
IndianOil Educational Scholarship Scheme