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teachers day
Government of West Bengal
Office of the PO cum DWO, MALDAH District

APPLICATION FOR POST-MATRIC SCHOLARSHIP TO SC/ST /OBC STUDENTS (AY: 2014-2015)
NEW /RENEWAL
Application Serial No. : WB03021786241
1. Full Name of Applicant Shri/Kumari : MD HAIDER ALI MOMIN
2. Father/Husband's Name MD KAMRUJJAMAN MOMIN.
3. Sex
Male
4. Date of Birth
5. Nationality :
INDIAN
6. Aadhar No
348709035012
7. Tele No.
8. a)Caste
OBC A
b) Sub-Caste

c) Caste Certification NoK.chak/145/2008
d) Dated
e)Issuing Authority
Sadar(SDO/ADM/DWO) f) District
9. a) State to which applicant actually belongs : West Bengal
b)
Permanent Address :
P.O.
CHASPARA
c)

9851481210
JOLAH (AN
SARIMOMIN)
18-06-2008
MALDAH

VILL+PO-CHASPARA PS-KALIACHAK

P.S.
KALIACHAK

District
MALDAH

PIN
732206

VILL+PO-CHASPARA PS-KALIACHAK

Present Address :
P.O.
CHASPARA

01-04-1992

P.S.
KALIACHAK

District
MALDAH

PIN
732206

d) Whether in full time employment Yes / No if yes, give details :
10. Particulars regarding Father / Mother / Husband / Guardian who supports in applicant’s studies
a) Name :
:MD KAMRUJJAMAN MOMIN
b) Occupation (if employed, give income certificate from the Employer) : DRIVER
c) Address :
:VILL+PO-CHASPARA
11. Bank Details :
Bank Name
State Bank of India

Branch
SUJAPUR

Savings A/C No.
30892008986

IFSC Code
SBIN0006810

MICR Code
732002506

12. a) Name of Institution (mentioning State / UT) : UNIVERSITY OF GOUR BANGA
Course Type:- Regular Full Time
b) Class of Study
c) Actual date of joining the
d) Tentative date of end of class(Academic year 14-15 only) session(Academic year 14-15 only)
Group II (M.A 1st year)
20-11-2013
03-09-2014
13. Annual Gross Income (parents / gurdians) from all sources : Rs. 48000
14. Whether applied for Merit/National Loan Scholarship or any other Stipend / Scholarship No
a) Whether pursuing any othe Course? if yes, give details of institute & Course
15. Whether you in
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