Scholarship Form

Reg No. E-17461

Khair-e-Ummat trust

B.I.T Chawl, Imamwada compound, Mumbai - 400 009. Tel.:2370 3782
Called On:
APPLICATION FOR SCHOLARSHIP

The Trustees,

I need financial assistance from your trust to continue my education. I assure you that I will take keen interest in my studies and will work hard to achieve good result. I will maintain integrity of my character and will try to set an examples for others to lead a successful life. I believe that real success means salvation in life after death, and hence the ultimate destination will never skip from my mind.

I hereby furnish my particulars as under for your kind perusal:
1. Name

Surname First Name father's Name
2. Contact No.

Mobile Whatsapp
2. Address (Hostel) :
3. Address (Permanent) :
4. Course of study : Partime / Full Time.
5. Duration of course : Govt. recognized / un recognized.
6. Name of institution & Address :
10. Total family income per month :
11. Total fees per annum :
12. How did you arrange last year's fees :
13. How much amount can be arranged by your family :
14. Are you availing any freeship in fees like E.B.C. / E.W.S. / Scholarship etc:
Yes No
We hereby solemnly affirms that the details given in the previous columns are true and complete
Applicant's Signature

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16. Parent's / Guardian's Sign

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Fees payable of institution's (Name) :
In case of Hostel, cheque to be issued in favor of :

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