Professional Documents
Culture Documents
Name of applicant (as per XII certificate) Date of Birth (DD/MM/YYYY) XII Roll No.
1. …../…./…………
Mother’s name ……………………………. Address for correspondence Year of Passing class XII
(First five subjects)
2. Marks obtained……. Out of 500
Name of the Board
(CBSE/ICSCE/STATE BOARD) (Tick)
Father’s name ……………………………. % age
3. -----------------------
Signature of Applicant*
10. --------------------------------------------------- DATE --------------------------
The facts stated above including fee by the applicant are hereby certified to be true and correct. The
character and good conduct of the applicant are also certified.
Recent Color
Photograph of the Signature of Principal -----------------------------
Applicant attested
and stamped by
Principal of
Name/Designation----------------------------------
11. Name of Inst. ---------------------------------------
School/Institution
where student is Tel & Mobile No.----------------------------------
presently studying Email ID--------------------------------------------
Affiliation No. Institution-------------------------
Seal--------------------------------------------------
CBSE Single Girl Child Merit Scholarship Scheme for Under-graduate studies
Eligibility:
Signature:
All the applications must be signed by the applicant. Unsigned applications will be rejected.
Attestation:
All the applications must be certified by the Principal of the present Institution where the admission has been obtained along
with his/her signature and stamp.
Bank Account Details:
Applicants should write their Bank Account number with detailed address of the Bank along with the Bank Code, MICR
Code and RTGS/NEFT code of the Bank. Applicant should open Bank Account in their name only. Scholarships will be
sent by ECS mode directly to Bank Account of the selected candidates. In case the Bank details as mentioned above are not
complete and in prescribed format the application will be rejected.
Change in Address
Any change in address must be immediately reported to “Dy. Secretary(A&V), CBSE, Shiksha Kendra, 2 Community Centre,
Preet Vihar, Delhi-110092”
DEPONENT
VERIFICATION
DEPONENT