gokdom.kar.nic.in : Pre-Matric Scholarship 2017-18 Institute Verification/ Self Declaration/ Income & Community Form Karnataka

Organisation : Karnataka Directorate of Minorities
Service Name : Pre-Matric Scholarship 2017-18 Institute Verification/ Self Declaration/ Income & Community Form
Applicable State : Karnataka
Scholarship Application Last Date : 31.08.2017 (Fresh) | 31.07.2017 (Renewal)
Website : https://dom.karnataka.gov.in/english
Institute Verification Form : https://www.scholarships.net.in/uploads/14419-Form.pdf

Pre-Matric Scholarship :

Scholarship Schemes 2017-18 Institute Verification/ Self Declaration/ Income & Community Formats

Related / Similar Scholarship :
GOKDOM FAQs 2017-18

Institution Verification Form :
Verification/information to be furnished by the Head of institution/school.

It is certified that the information provided below by _________________ who is admitted in ________________ class for the academic session ___________ in ______________ is correct as per the records/documents verified with a copy of it maintained in institution/school, He/ She is a hosteller/day scholar of the school.

Last year marks details:
Fee details current year:

In case the information filled in these columns is not correct, then the institute / school should indicate that separately.
___________________________________________________________________________
___________________________________________________________________________

Date:__________
Place:_________

Note:
(i) The verification by institution is mandatory for consideration of the application.
(ii) Students are directed to take the print out of ‘Institution Verification Form’ get it verified by their institution/school, in order to apply for Pre Matric scholarship.

Proforma For Declaration Of Minority Community:
Self Declaration Of Minority Community By Student For Pre Matric Scholarship Scheme 2017-18

Declaration:
I, ____________________________Son/Daughter/ward of __________________________ hereby declare that I belong to the____________________________ (Muslims/Sikhs/Christians/Buddhists/Jains and Zoroastrians (Parsis) which is a notified minority community as per Section 2(c) of National Commission for Minorities Act, 1992).

Date:__________
Place:_________
Signature of Candidate: ______________
Name of Candidate: _________________

Self Declaration :
Self Declaration Of Family Income Under Pre Matric Scholarship Scheme (For Class I To X) Of Ministry Of Minority Affairs, Government Of India (To be given by the Parent/Legal Guardian)

I, ____________________________Son/Daughter/of___________________________ Resident of (full address)__________________________________________________ ______________________________________________________________________ do hereby solemnly affirm and declare as under :-

a) That I am citizen of India.
b) That my son/daughter/ward namely Master/Kumari _______________________ is a student of class _______ in ______________________________________ (name & address of school) _________________________________________ at ___________________ (District & State).
c) His/Her enrollment no. in school is _____________________for the academic Session _________.
d) That annual income of my family from all sources is Rs ………………(in words also) ……………………………………………………………………………………
e) I declare that I/my wife/ both* am/are earning Member(s) in my family.

2. I certify that the above information given by me is true.

3. In case this information furnished by me is found false, the financial assistance awarded to my ward may be recovered with penal interest and I will be liable to a legal action against me in accordance with law.

Signature of Parent/Legal Guardian:__________________________
Name of Parent/Legal Guardian: ____________________________

Note:
*Strike off the non-applicable part in the underlined clause above.