GOLDEN JUBILEE SCHOLARSHIP SCHEME 2013-14

EMBASSY OF INDIA, KATHMANDU

CONSULATE GENERAL OF INDIA, BIRGUNJ (NEPAL)

[FOR UNDERGRADUATE COURSES IN NEPAL]

Note: / 1.One copy of this application form is to be submitted with attested copies of required enclosures. Attestation may be done by the Principal, College Campus Chief, Head of the College Administration branch or a gazetted officer.
2.All entries should be made in Capitalletters. Read the instructions carefully before filling the Application Form.
1. Course Studying: (MBBS / BE / Other Courses of three year duration viz. BA, BSc, BBS, BBA, B.Com etc.) [Indicate only one] / / BA
2.District to which candidate belongs
[100 scholarships will be reserved for students belonging to 25 districts identified by Government of Nepal. See details in advertisement] / / Kathmandu
3.Eligibility: / Marks in Class 12th
[at least 70% marks in aggregate] /
/ 81.25%
Age as on July 1st, 2013
[between 17 and 22 years] / 18yrs.
Family Income of the Candidate
[must be less than NRs. 1,20,000/- per annum] / 90,0000/-

4. Personal particulars:

Name / Sanjay Poudel
Date of Birth / a) In Christian Era: 1995-03-21
b) In BikramSamwat:
c) Age as on 01 July 2013
Years 18 Month 03 Day 17
Father’s Name and Occupation / Ram Prasad Poudel
Farmer
Mother’s Name and Occupation / Sarita
Housewife
Permanent Residential Address / Ward No.10 Kathmandu
Correspondence Address / Ward No.10 Kathmandu
Telephone No./
E mail address / 9897654123

5. Details of Nepalese Citizenship Certificate number:

Nepalese citizenship certificate number / 6799045
[Candidates who are not holding citizenship certificate can enclose copy of citizenship certificate either of mother or of father.]
Date and place of issue / Kathmandu

(Please attach copy of citizenship certificate)

6. Educational Qualification: Class XII /I.Sc /I.A./I.Com

Name of Institute with phone/ FAX Number(*) / Pentagon College, Kathmandu
Year of passing / 2013/2070
Class XII /I.Sc /I.A./I.Com (Class XI marks not to be included) / Total Marks
800 / Marks Obtained
650 / Overall Percentage
81.25%

7. Details of Institution/college in Nepal where student is studying in 1st Year 1st semester:

Name of Institute with phone/ FAX Number(*) / Nepal College-Kathmandu
Name of Undergraduate course and duration of course / BA

(Please attach certificate from College/ University concerned)

8. Details of Annual family income (NRs):90,000/-

Certified that the annual family income of Mr/Ms.Ramesh Poudel is less than NRs,1,20,000/-.
Signature of CDO/VDC Head with stamp/seal

9.

  1. Whether children of serving/ex-servicemen (soldiers) of Indian Army. If yes, attach a copy of relevant certificate issued by competent authority.
/ (Yes/ No)-No
  1. Whether the student is receiving full or partial scholarship from any other organization/govt. If yes please specify details.
Signature of College Principal with stamp/seal / (Yes/ No)-No

I certify that information/details furnished in the above Application Form are correct to the best of my knowledge and belief. I am also aware that my application/selection will be rejected/ annulled if any facts stated above are found to be incorrect. I also undertake that if selected, I will furnish the mark sheet within a period of 30 days after the declaration of the result of first year and thereafter every subsequent year failing which my scholarship would be discontinued. I also certify that I have not received scholarship from any other institutions.

Date: Place: Signature of the candidate

Note: (*) Phone No/ Fax No. of College/ University required by the Embassy to verify details furnished by the candidate. Applicants are advised to check Indian Embassy website regarding their short listing for interview and date, time and venue of interview.