(To: JM Sethia Charitable trust of 16, Ganesh Chandra Avenue, Kolkata-700013,West Bengal, INDIA, fon: +91-33-2236 0368,4040 1300, mob : +91-9339793153, West Bengal, INDIA, e-mail: jms_trust@yahoo.in, website: www.jmstrust.com)

Note : INSTRUCTION :-

Do not Fillip application form repeatedly.
Form Should be Fill up in English letters only (Do not use any regional language).
Scholarship scheme is not applicable for candidates preparing for competitive exams.

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

* Required Mandatory

GENERAL INFORMATION (Category applied for Pl. Tick ) Please refer to the scheme
ABCDPO

1.Your name *

2. Upload Your Passport Size Photo (Size: 1mb) *

3.Son/ Daughter of *

4.Date of birth : *

5.Mobile No: *

6.e-mail id: *

7.Postal Address of the Applicant * :

8.Pincode *

9.Tel. No. (with STD Code)

10.Select your States *

11.Select your City *

[group MentionCities]
11A. Mention City Name: (If Your City/Town not in above list)

[/group]

12. Select Your District *

13.Update Your Bank details (Select Your Bank) *

14.Choose Your Gramin Bank(optional)

15.Bank Branch Address *

16.IFSC CODE *

17.Merit Scholarship Scheme Application Form(optional)

18.Aggregate % Marks obtained in last class Passed (Please write in % only) *

19.Name Of School / College / Institution / University (PASSED) *

20.Address Of School / College / Institution (PASSED) *

21.Select your School States (PASSED) *

22.Select your School City (PASSED) *

[group PassedCities]
22A.Mention your School City Name: (If Your City/Town not in above list)

[/group]

23.Pin Code of School / College / Institution (PASSED) *

(Please enter correct pincode as per school Address)

24.Subjects *
Maths / MathematicsAlgebraGeometryBiologyPhysicsChemistryGeographyHistoryCitizenshipPhysical Education (P.E)Business StudiesHome EconomicsTrigonometryStatisticsEnglishHindiBengaliComputer ApplicationStatisticalEconomicsComputer ScienceScienceSanskritAccountsSocial SciencePhysical ScienceLife ScienceUrduOther Subjects

[group PassedSubject]
24A.If Others Subject, Please Specify (Passed)
[/group]

25. Name Of School / College / Institution (PRESENTLY PURSUING) *

26.Address Of School / College / Institution (PRESENTLY PURSUING) *

27. Select your School States (PRESENTLY PURSUING) *

28.Select your School Cities (PRESENTLY PURSUING) *

[group If_required_Pursuing_Cities]
28A.Mention your School City Name: (If Your City/Town not in above list)

[/group]

29. Pincode Of School / College / Institute (PRESENTLY PURSUING) *

30.Mobile No of Your School (PRESENTLY PURSUING) *

31.Tel. No. (with STD Code) (PRESENTLY PURSUING)

32.Class / Course (PRESENTLY PURSUING) *

33.Course Duration (No, of Years) PRESENTLY PURSUING *

34.Subjects (PRESENTLY PURSUING) *
Maths / MathematicsAlgebraGeometryBiologyPhysicsChemistryGeographyHistoryCitizenshipPhysical Education (P.E)Business StudiesHome EconomicsTrigonometryStatisticsEnglishHindiBengaliComputer ApplicationStatisticalEconomicsComputer ScienceScienceSanskritAccountsSocial sciencePhysical ScienceUrduOthers Subject
[group PursuingOtherSubjects]
34A.If Others Subject, Please Specify (Pursuing)
[/group]

35.Economic (Financial Standing) (Enclose Copy of Last Income Tax Return Field or else any proof of income document.) *

35A. Parents Annual Income Rs

35B. If Parents are Income Tax Assess, then PAN No. of anyone

36. Is Reservation applicable (Optional): If yes, Then PL Check in the related box & enclosed the copy of certificate/documentary evidence if any :-

Special Category- HandicappedExcellence extra- curricular activities like sports, NCC B certificate holder , debating, dramatics & social servicesEconomically weakersection – of those students, whose presents annual income is not more than Rs, 1,20,000/-

37. CHECKLIST – for enclosures, PL tick,(Pl UPLOAD YOUR DETAILS ) * :-
Copy of marksheetCopy of Proof of Income documentCopy of certificate providing reservation

38. Please Upload your Hardcopy Of the Marksheet, Proof Of Income Document, Special Categories Certificate (File Size 10mb):- *
39. DECLARATION *
I/We hereby declared 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 Scholarships. In case Of any discrepancy found at any point in time. I / We would be responsible for the cancellation of the Scholarship &refund of the money received on this behalf. I/We further state that no other scholarship is claimed from any other sources. I would be entitled to the Scholarship as long as I a enrolled in the above-mentioned course / College /institution. I shall furnish a quarterly declaration continuity certificate obtained from the Principal / Head / of the Institute & authentication about the utilization of the scholarship amount every failing which scholarship amount will be stopped.

I/We accept the terms & condition