Merit Scholarship Scheme Application From
  • Please read these instructions carefully before filling up the form either Electronically or Manually.
  • The from is to be hand/type written legibly in English in Capital letters using blue/black ink only.
  • Attested copies of certificate/marksheet necessary support documents should be attached with this Application From.
  • Please tick mark where necessary.
  • Incomplete forms without enclosures, wherever necessary, will not be considered. Leave no column blank. Please write “Not Applicable” wherever necessary.
  • Completed application form should be addressed to Chief Trustee and sent to JM SETHIA CHARITABLE TRUST, at its Regd. & Head Office at 133, Biplabi Rash Behari Basu road, 3rd Floor No. 15, Kolkata – 700 001, or at its Admn. Office at Gandhi House, 5th Floor, 16, Ganesh Chandra Avenue, Kolkata – 700 013, Phone: +91 33 22360368 / 67, Mobile: +91 93397 93153., Website:
  • Date for Submission of Application Form - April to July; Date of Selection of Candidate - August and Date of Disbursement of Scholarship - September OR within the month prior to the next quarter

General Information

Category applied for. Please choose (Please refer to the Scheme).
  Duration from to
1. Name & Postal Address of the Applicant
Pin Code
2. Date of Birth 3. Tel. No.(with STD Code) 4. Mobile No
5. Name & Address of Nearest Bank available from your place
Pin Code
6. Name & Address of Last School/College/Institution attended
Pin Code
7. ACADEMIC (Enclose marksheet copy of the examination passed)
Name of Board/University Passed

Subject (s) opted

Aggregate % marks obtained

Name & Addreress with PIN of
Class/Course Duration (No. Of Years)


8. Economic (financial Standing)(Enclose Copy of Last Income Tax Return Filed or else any one proof of income document.)
1. Parents Annual Income Rs. 2. If income Tax Assesse, then PAN No.
9. Is Reservation applicable. If Yes, then Pl. tick in the related box and enclose the copy of certificate / documentary evidence if any.
I. Special Category - handicapped
II. Excellence extra-curricular activities like sports, NCC 'B' certificate holder, debating, dramatics & social services.
III. Economically weaker section - of those students, whose parents Annual Income bis not more than Rs. 1,20,000/-
(Rupees One lac twenty thousand only)
10. CHECKLIST for enclosures, Pl. tick
I) Copy of marksheet, for point No. 7
II) Copy of Proof of Income document for Point No. 8
III) Copy of certificate proving reservation for point No. 9
After Submit please take a printout, sign Declaration, complete Recommendation from the Head of the Institution and send it to us to complete the Application process fully

I/We hereby declare that the information provided is true to the best of my/our knowledge and nothing is concealed/misrepresented. JM SETHIA CHARITABLE TRUST Management’s decision will be final and decisive for selecting and granting Scholarship. In case of any discrepancy found at any point of time. I/We would be responsible for cancellation of Scholarship and refund of money received on this behalf. I/We further state that no other Scholarship is claimed from any other sources. I would be entitled for the Scholarship as long as I am enrolled in the above mentioned course/college/institution. I shall furnish quarterly declaration continuity certificate obtained from the Principal/Head of the Institute and authentication about the utilization of Scholarship amount every quarter failing which scholarship amount will be stopped.


Signature of Applicant


This is to Certify that   S/o./D/o./Shri/Smt.  
  is a student of the Institution and enrolled
for course under Registration
His/Her performance and conduct in the institution has been consistently good. We have no record of him/her availing any oyher Scholarship. I recommend him/her for consideration for JM SETHIA CHARITABLE TRUST merit Scholarship Scheme.
special comments, if any

Name of Institution date Signature of Principal with Seal