Inter R.No:__0910212246______ Group :__M.P.

C____,Marks: 953

RENEWAL APPLICATION
MHRD, Department of Higher Education, Govt of India, New Dehli. Form for Renewal of Scholarship for the year 201 0- 2011 Name of the Bachelor Degree course, whether promoted to the next class and percentage of marks obtained in annual / semester exams in the relevant year (CSSS for College & University students) % of Attendance

Name of Degree / PG Course:

B.Tech,3rdYEAR
On line facility Bank A/c particulars

Schp. IDNo.

S/BC/B/914 /2009

Name of the student with Fathers name & e-mail-ID

Name(as on sign board) & Postal Address of the College, where Candidate is studying now. Degree College:

NATIONAL INSTITUTE

C.SUDHEENDRACHARI s/o
C.T.SURYANARAYANACHARI

OF TECHNOLOGY, CALICUT
Address: NITC CAMPUS (P.O) CHATAMANGALAM,

Remarks State and Board from which Regarding class 12 exams appeared, discipline of year of passing and Roll.No., the student, group, marks, Shp ID.No. as including given in the fresh final ragging, etc., selection list. A.P.,

Bank Name:_STATE BANK OF INDIA ______________________________

a) Name of the Bachelor Degree / PG Degree Course: ELECTRONICS AND COMMUNICATION ENGINEERING b) whether promoted to next class : - Yes / No c) I year % of marks: 73.25 d) II year % of marks: 69.5 e) III year % of marks:(PURSUING 3rd YEAR) f) IV year / I year P.G. % of marks: (PURSUING 3rd YEAR)
Note: Convert the CGPA into % of Marks & Furnish Year Wise in % of Marks.

KOZHIKODE Dist. KOZHIKODE State: KERALA Pin : 673601 _________________________________ If studying PG:
Name of the PG Course:________________ Admission No. _______________________

E-Mail ID:

BIE, A.P., Hyderabad IPE March 20 Roll.No: 0910212246

Branch: CREC BRANCH, CHATAMANGALAM

Branch Code:___02207_____________ Bank S.B A/c No.:

csc.929@gmail.com
Telephone No.

80 80

-NIL-

Group in Inter:__

M.P.C

Marks in Inter: 953 Schp.ID NO:

08518-274539
Mobile No.

Date:____________ Name of the PG College:_____________ _________________________________

Address:

S/BC/B/914 /2009
(as provided in the final selection list) IFSC code:

30840449014 SBIN0002207

9037635538

_______________________________ Dist.________ State_________ Pin_______ _________________________________ _ Telephone No. ____________________ Mobile No.

(Above particulars must be furnished)

Certified that the particulars given above are true. 1) 2) 3) 4) Scholarship ID No. as provided in final selection list is to be filled compulsorily without which renewal scholarships can not be sanctioned. th This form has to be sent as early as possible (on or before 15 July of Every Year (OR) as stated in covering letter) Incomplete and late received forms will be rejected. Further information on MHRD CSS Scholarship is available at BIE Website: www.bieap.gov.in

Signature of the Principal (Bachelor Degree Course)/PG Course, Head of the Institute with College Seal.

And Enclose: a. Attested copy of Degree Marks Sheet. b. Xerox copy of Bank pass book page where Bank Account Number (having on line facility) and students name as mentioned in the Intermediate Pass Certificate are reflected. To be sent to: nd 1.The Director (National Scholarship ) Ministry of Human Resource Development, Government of India, Department of Higher Education, West Block 1, Wing 6, 2 Floor, Ramakrishnapuram, New Delhi 110066. 2. A copy of the same may be sent to the Secretary, Board of Intermediate Education, A.P., Vidya Bhavan, Nampally, Hyderabad -500001.