R.C.No:682 PROFORMA TO BE SUBMITTED BY THE STUDENT FOR PRATIBHA AWARDS - 2015

ANNEXURE - I
PROFORMA TO BE SUBMITTED BY THE STUDENT FOR
PRATIBHA AWARDS - 2015


1.   Name of the Student                             :

2.    Father  / Guardian Name                       :

3.   Phone number(Mobile No)                     :

4.    Name of the School / address , where    :
student  appeared SSC examination

5.     Residential Address                                       :

6.    Name of the College / Institution           :
 where he/she is admitted for further
studies.

7.    Name of the course pursuing now           :

8.    Admission No.                                     :

9.    Adhaar Card No.                                  :

10. Name of the Bank                                :

11. Branch                                                :

12.  Account No.                                       :
(*If bank account is not available,                  
A new bank A/c should be opened by
the student’s name only.)

13. IFSC Code                                           :

14. MICR Code                                          :       

15. The Xerox copy of the 1st page              :
of the latest bank pass book
should be enclosed
                                     

The above information is verified and found correct.





Signature of the student                                 Signature of the Head Master

                   with stamp


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