Organization : Assam Directorate of Secondary Education
Scholarship Name : One Time Financial Aid
Applicable For : Retired Teachers
Applicable State : Assam
Website : http://www.madhyamik.in/news/resources.asp?NAV=5
Application Form : https://www.scholarships.net.in/uploads/10074-Teacher.pdf
One Time Financial Aid:
Application form for one time financial assitance from the national foundation for teachers welfare, state working committee assam.
Related : Madhyamik 2016 National Talent Search Exam Assam : www.scholarships.net.in/9960.html
To be submitted to the Director of Secondary Education with the recommendation of Inspector of School /District Elementary Education Officer /Principal of the College
Application Format:
1. Name in Block capital letters _______________________________________
2. (a)Fathers name
(b) Name of Spouse if any
3. Present Address with Post office and PS
name
Po.
Village/Ward Town
District
4. Contact Number
a) Mobile NO.
b) Email if any
5. Name of the Post from which retired with name of School /College and District in bold letters ;
a) Post
b) School/College
c) District
6. Was the School /College Govt. or Provincialised.
a) Govt.
b) Provincialised
7 Date of Retirement,
8. Whether Regular Pension (PPO) Received or drawing Provisional Pension attach a copy of PPO or the Prv. Pension order and present monthly Pension amount
Yes /NO.
Pension amount;- Rs.
9. Nature of ailment suffering from and since when? (Tick the appropriate Choice)
a) Cancer
b) Heart Surgery
c) Kidney Transplant
d) Serious accident (State nature) date of incident and status of treatment
e) Date from when suffered
10 . Name of the Hospital (s) where treatment was done (Attach one or more certificates /documents as proof )
1.
2.
3
10 (A). Approximate amount of money spent on treatment so far Rs……………………………………………………………………
11 Sources of income and approximate annual income from such sources.
(a) Pension……………………………………………
(b) Agriculture…………………………………………….
(c) Business………………………………………………….
(d) Other sources………………………………………………….
12 Whether you received medical reimbursement? If so quantum of medical reimbursement received from government or other organisation by you
Rs……………………………………………from State Govt.
Rs……………………………… from other organisation
13 Is there any earning member in the family? YES/NO If yes, approximate annual Income of such member Rs…………………………………………………………..
14 Bank Details Bank A/C No. With name of Bank and IFSC Code
Bank Name……………………………………………………………….
Branch…………………………………………………………….
Account No……………………………………………………………
IFSC Code……………………………………………………………….
Declaration:
I hereby certify that the above information is true to the best of my knowledge and nothing has been concealed.
Full Signature of the Applicant
Name :
Date :
Place :
Recommendation of the Inspector of School/DEEO/Principal.
I certify that Sri/Srimati ……………………………………………………………………………………has been suffering from the medical condition as stated above in the application and his /her economic condition is that he/she deserves some financial grants to provide some relief.
Signature
Name of IS /DEEO/Principal
Date and Place
Office Seal