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* 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 *
—Please choose an option—Select OneAndaman and Nicobar Islands (union territory)Andhra PradeshArunachal PradeshAssamBiharChandigarh (union territory)ChhattisgarhDadra and Nagar Haveli (union territory)Daman and Diu (union territory)Delhi (national capital territory)GoaGujaratHaryanaHimachal PradeshJammu and Kashmir (union territory)JharkhandKarnatakaKeralaLadakh (union territory)Madhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherry (union territory)PunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal

11.Select your City *
—Please choose an option—Select OnePort BlairAdoniAmaravatiAnantapurChandragiriChittoorDowlaiswaramEluruGunturKadapaKakinadaKurnoolMachilipatnamNagarjunakoṇḍaRajahmundrySrikakulamTirupatiVijayawadaVisakhapatnamVizianagaramYemmiganurItanagarAdoniAmaravatiAnantapurChandragiriChittoorDowlaiswaramEluruGunturKadapaKakinadaKurnoolMachilipatnamNagarjunakoṇḍaRajahmundrySrikakulamTirupatiVijayawadaVisakhapatnamVizianagaramYemmiganurItanagarDhuburiDibrugarhDispurGuwahatiJorhatNagaonSibsagarSilcharTezpurTinsukiaAraBaruniBegusaraiBettiahBhagalpurBihar SharifBodh GayaBuxarChapraDarbhangaDehriDinapur NizamatGayaHajipurJamalpurKatiharMadhubaniMotihariMungerMuzaffarpurPatnaPurniaPusaSaharsaSamastipurSasaramSitamarhiSiwanAmbikapurBhilaiBilaspurDhamtariDurgJagdalpurRaipurRajnandgaonSilvassaDamanDiuDelhiNew DelhiMadgaonPanajiAhmadabadAmreliBharuchBhavnagarBhujDwarkaGandhinagarGodhraJamnagarJunagadhKandlaKhambhatKhedaMahesanaMorviNadiadNavsariOkhaPalanpurPatanPorbandarRajkotSuratSurendranagarValsadVeravalAmbalaBhiwaniChandigarhFaridabadFirozpur JhirkaGurgaonHansiHisarJindKaithalKarnalKurukshetraPanipatPehowaRewariRohtakSirsaSonipatBilaspurChambaDalhousieDharmshalaHamirpurKangraKulluMandiNahanShimlaUnaAnantnagBaramulaDodaGulmargJammuKathuaPunchRajauriSrinagarUdhampurBokaroChaibasaDeogharDhanbadDumkaGiridihHazaribagJamshedpurJhariaRajmahalRanchiSaraikelaBadamiBallariBangaloreBelgaviBhadravatiBidarChikkamagaluruChitradurgaDavangereHalebidHassanHubballi-DharwadKalaburagiKolarMadikeriMandyaMangaluruMysuruRaichurShivamoggaShravanabelagolaShrirangapattanaTumkuruAlappuzhaBadagaraIdukkiKannurKochiKollamKottayamKozhikodeMattancheriPalakkadThalasseryThiruvananthapuramThrissurBalaghatBarwaniBetulBharhutBhindBhojpurBhopalBurhanpurChhatarpurChhindwaraDamohDatiaDewasDharGunaGwaliorHoshangabadIndoreItarsiJabalpurJhabuaKhajurahoKhandwaKhargonMaheshwarMandlaMandsaurMhowMorenaMurwaraNarsimhapurNarsinghgarhNarwarNeemuchNowgongOrchhaPannaRaisenRajgarhRatlamRewaSagarSarangpurSatnaSehoreSeoniShahdolShajapurSheopurShivpuriUjjainVidishaAhmadnagarAkolaAmravatiAurangabadBhandaraBhusawalBidBuldanaChandrapurDaulatabadDhuleJalgaonKalyanKarliKolhapurMahabaleshwarMalegaonMatheranMumbaiNagpurNandedNashikOsmanabadPandharpurParbhaniPuneRatnagiriSangliSataraSevagramSolapurThaneUlhasnagarVasai-VirarWardhaYavatmalImphalCherrapunjiShillongAizawlLungleiKohimaMonPhekWokhaZunhebotoBalangirBaleshwarBaripadaBhubaneshwarBrahmapurCuttackDhenkanalKeonjharKonarkKoraputParadipPhulabaniPuriSambalpurUdayagiriKaraikalMahePuducherryYanamAmritsarBatalaChandigarhFaridkotFirozpurGurdaspurHoshiarpurJalandharKapurthalaLudhianaNabhaPatialaRupnagarSangrurAbuAjmerAlwarAmerBarmerBeawarBharatpurBhilwaraBikanerBundiChittaurgarhChuruDhaulpurDungarpurGanganagarHanumangarhJaipurJaisalmerJalorJhalawarJhunjhunuJodhpurKishangarhKotaMertaNagaurNathdwaraPaliPhalodiPushkarSawai MadhopurShahpuraSikarSirohiTonkUdaipurGangtokGyalsingLachungManganArcotChengalpattuChennaiChidambaramCoimbatoreCuddaloreDharmapuriDindigulErodeKanchipuramKanniyakumariKodaikanalKumbakonamMaduraiMamallapuramNagappattinamNagercoilPalayankottaiPudukkottaiRajapalaiyamRamanathapuramSalemThanjavurTiruchchirappalliTirunelveliTiruppurTuticorinUdhagamandalamVelloreHyderabadKarimnagarKhammamMahbubnagarNizamabadSangareddiWarangalAgartalaAgraAligarhAmrohaAyodhyaAzamgarhBahraichBalliaBandaBara BankiBareillyBastiBijnorBithurBudaunBulandshahrDeoriaEtahEtawahFaizabadFarrukhabad-cum-FatehgarhFatehpurFatehpur SikriGhaziabadGhazipurGondaGorakhpurHamirpurHardoiHathrasJalaunJaunpurJhansiKannaujKanpurLakhimpurLalitpurLucknowMainpuriMathuraMeerutMirzapur-VindhyachalMoradabadMuzaffarnagarPartapgarhPilibhitPrayagrajRae BareliRampurSaharanpurSambhalShahjahanpurSitapurSultanpurTehriVaranasiAlmoraDehra DunHaridwarMussoorieNainitalPithoragarhAliporeAlipur DuarAsansolBaharampurBallyBalurghatBankuraBaranagarBarasatBarrackporeBasirhatBhatparaBishnupurBudge BudgeBurdwanChandernagoreDarjilingDiamond HarbourDum DumDurgapurHalisaharHaoraHugliIngraj BazarJalpaiguriKalimpongKamarhatiKanchraparaKharagpurKoch BiharKolkataKrishnanagarMaldaMidnaporeMurshidabadNavadwipPalashiPanihatiPuruliaRaiganjSantipurShantiniketanShrirampurSiliguriSiuriTamlukTitagarhOthers Cities

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

[/group]

12. Select Your District *
Select OneNicobarNorth Middle AndamanSouth AndamanAnantapurChittoorEast GodavariAlluri Sitarama RajuAnakapalliAnnamayaBapatlaEluruGunturKadapaKakinadaKonaseemaKrishnaKurnoolManyamN T Rama RaoNandyalNellorePalnaduPrakasamSri BalajiSri Satya SaiSrikakulamVisakhapatnamVizianagaramWest GodavariAnjawCentral SiangChanglangDibang ValleyEast KamengEast SiangKamleKra DaadiKurung KumeyLepa RadaLohitLongdingLower Dibang ValleyLower SiangLower SubansiriNamsaiPakke KessangPapum PareShi YomiTawangTirapUpper SiangUpper SubansiriWest KamengWest SiangBajaliBaksaBarpetaBiswanathBongaigaonCacharCharaideoChirangDarrangDhemajiDhubriDibrugarhDima HasaoGoalparaGolaghatHailakandiHojaiJorhatKamrupKamrup MetropolitanKarbi AnglongKarimganjKokrajharLakhimpurMajuliMorigaonNagaonNalbariSivasagarSonitpurSouth Salmara-MankacharTamulpurTinsukiaUdalguriWest Karbi AnglongArariaArwalAurangabadBankaBegusaraiBhagalpurBhojpurBuxarDarbhangaEast ChamparanGayaGopalganjJamuiJehanabadKaimurKatiharKhagariaKishanganjLakhisaraiMadhepuraMadhubaniMungerMuzaffarpurNalandaNawadaPatnaPurniaRohtasSaharsaSamastipurSaranSheikhpuraSheoharSitamarhiSiwanSupaulVaishaliWest ChamparanChandigarhBalodBaloda BazarBalrampurBastarBemetaraBijapurBilaspurDantewadaDhamtariDurgGariabandGaurela Pendra MarwahiJanjgir ChampaJashpurKabirdhamKankerKhairagarhKondagaonKorbaKoriyaMahasamundManendragarhMohla ManpurMungeliNarayanpurRaigarhRaipurRajnandgaonSaktiSarangarh BilaigarhSukmaSurajpurSurgujaDadra and Nagar HaveliDamanDiuCentral DelhiEast DelhiNew DelhiNorth DelhiNorth East DelhiNorth West DelhiShahdaraSouth DelhiSouth East DelhiSouth West DelhiWest DelhiNorth GoaSouth GoaAhmedabadAmreliAnandAravalliBanaskanthaBharuchBhavnagarBotadChhota UdaipurDahodDangDevbhoomi DwarkaGandhinagarGir SomnathJamnagarJunagadhKhedaKutchMahisagarMehsanaMorbiNarmadaNavsariPanchmahalPatanPorbandarRajkotSabarkanthaSuratSurendranagarTapiVadodaraValsadAmbalaBhiwaniCharkhi DadriFaridabadFatehabadGurugramHisarJhajjarJindKaithalKarnalKurukshetraMahendragarhMewatPalwalPanchkulaPanipatRewariRohtakSirsaSonipatYamunanagarBilaspurChambaHamirpurKangraKinnaurKulluLahaul SpitiMandiShimlaSirmaurSolanUnaAnantnagBandiporaBaramullaBudgamDodaGanderbalJammuKathuaKishtwarKulgamKupwaraPoonchPulwamaRajouriRambanReasiSambaShopianSrinagarUdhampurBokaroChatraDeogharDhanbadDumkaEast SinghbhumGarhwaGiridihGoddaGumlaHazaribaghJamtaraKhuntiKodermaLateharLohardagaPakurPalamuRamgarhRanchiSahebganjSeraikela KharsawanSimdegaWest SinghbhumBagalkotBangalore RuralBangalore UrbanBelgaumBellaryBidarChamarajanagarChikkaballapurChikkamagaluruChitradurgaDakshina KannadaDavanagereDharwadGadagGulbargaHassanHaveriKodaguKolarKoppalMandyaMysoreRaichurRamanagaraShimogaTumkurUdupiUttara KannadaVijayanagaraVijayapuraYadgirAlappuzhaErnakulamIdukkiKannurKasaragodKollamKottayamKozhikodeMalappuramPalakkadPathanamthittaThiruvananthapuramThrissurWayanadKargilLehLakshadweepAgar MalwaAlirajpurAnuppurAshoknagarBalaghatBarwaniBetulBhindBhopalBurhanpurChachauraChhatarpurChhindwaraDamohDatiaDewasDharDindoriGunaGwaliorHardaHoshangabadIndoreJabalpurJhabuaKatniKhandwaKhargoneMaiharMandlaMandsaurMorenaNagdaNarsinghpurNeemuchNiwariPannaRaisenRajgarhRatlamRewaSagarSatnaSehoreSeoniShahdolShajapurSheopurShivpuriSidhiSingrauliTikamgarhUjjainUmariaVidishaAhmednagarAkolaAmravatiAurangabadBeedBhandaraBuldhanaChandrapurDhuleGadchiroliGondiaHingoliJalgaonJalnaKolhapurLaturMumbai CityMumbai SuburbanNagpurNandedNandurbarNashikOsmanabadPalgharParbhaniPuneRaigadRatnagiriSangliSataraSindhudurgSolapurThaneWardhaWashimYavatmalBishnupurChandelChurachandpurImphal EastImphal WestJiribamKakchingKamjongKangpokpiNoneyPherzawlSenapatiTamenglongTengnoupalThoubalUkhrulEast Garo HillsEast Jaintia HillsEast Khasi HillsMairangNorth Garo HillsRi BhoiSouth Garo HillsSouth West Garo HillsSouth West Khasi HillsWest Garo HillsWest Jaintia HillsWest Khasi HillsAizawlChamphaiHnahthialKolasibKhawzawlLawngtlaiLungleiMamitSaihaSerchhipSaitualChumukedimaDimapurKiphireKohimaLonglengMokokchungMonNiulandNoklakPerenPhekShamatorTseminyuTuensangWokhaZunhebotoAngulBalangirBalasoreBargarhBhadrakBoudhCuttackDebagarhDhenkanalGajapatiGanjamJagatsinghpurJajpurJharsugudaKalahandiKandhamalKendraparaKendujharKhordhaKoraputMalkangiriMayurbhanjNabarangpurNayagarhNuapadaPuriRayagadaSambalpurSubarnapurSundergarhKaraikalMahePuducherryYanamAmritsarBarnalaBathindaFaridkotFatehgarh SahibFazilkaFirozpurGurdaspurHoshiarpurJalandharKapurthalaLudhianaMalerkotlaMansaMogaMohaliMuktsarPathankotPatialaRupnagarSangrurShaheed Bhagat Singh NagarTarn TaranAjmerAlwarBanswaraBaranBarmerBharatpurBhilwaraBikanerBundiChittorgarhChuruDausaDholpurDungarpurHanumangarhJaipurJaisalmerJaloreJhalawarJhunjhunuJodhpurKarauliKotaNagaurPaliPratapgarhRajsamandSawai MadhopurSikarSirohiSri GanganagarTonkUdaipurEast SikkimNorth SikkimPakyongSorengSouth SikkimWest SikkimAriyalurChengalpattuChennaiCoimbatoreCuddaloreDharmapuriDindigulErodeKallakurichiKanchipuramKanyakumariKarurKrishnagiriMaduraiMayiladuthuraiNagapattinamNamakkalNilgirisPerambalurPudukkottaiRamanathapuramRanipetSalemSivagangaTenkasiThanjavurTheniThoothukudiTiruchirappalliTirunelveliTirupatturTiruppurTiruvallurTiruvannamalaiTiruvarurVelloreViluppuramVirudhunagarAdilabadBhadradri KothagudemHyderabadJagtialJangaonJayashankarJogulambaKamareddyKarimnagarKhammamKomaram BheemMahabubabadMahbubnagarMancherialMedakMedchalMuluguNagarkurnoolNalgondaNarayanpetNirmalNizamabadPeddapalliRajanna SircillaRanga ReddySangareddySiddipetSuryapetVikarabadWanaparthyWarangalHanamkondaYadadri BhuvanagiriDhalaiGomatiKhowaiNorth TripuraSepahijalaSouth TripuraUnakotiWest TripuraAgraAligarhAmbedkar NagarAmethiAmrohaAuraiyaAyodhyaAzamgarhBaghpatBahraichBalliaBalrampurBandaBarabankiBareillyBastiBhadohiBijnorBudaunBulandshahrChandauliChitrakootDeoriaEtahEtawahFarrukhabadFatehpurFirozabadGautam Buddha NagarGhaziabadGhazipurGondaGorakhpurHamirpurHapurHardoiHathrasJalaunJaunpurJhansiKannaujKanpur DehatKanpur NagarKasganjKaushambiKheriKushinagarLalitpurLucknowMaharajganjMahobaMainpuriMathuraMauMeerutMirzapurMoradabadMuzaffarnagarPilibhitPratapgarhPrayagrajRaebareliRampurSaharanpurSambhalSant Kabir NagarShahjahanpurShamliShravastiSiddharthnagarSitapurSonbhadraSultanpurUnnaoVaranasiAlmoraBageshwarChamoliChampawatDehradunHaridwarNainitalPauriPithoragarhRudraprayagTehriUdham Singh NagarUttarkashiAlipurduarBankuraBirbhumCooch BeharDakshin DinajpurDarjeelingHooghlyHowrahJalpaiguriJhargramKalimpongKolkataMaldaMurshidabadNadiaNorth 24 ParganasPaschim BardhamanPaschim MedinipurPurba BardhamanPurba MedinipurPuruliaSouth 24 ParganasUttar Dinajpur

13.Update Your Bank details (Select Your Bank) *
Select OneAllahabad BankAndhra BankAxis BankBank of Bahrain and KuwaitBank of Baroda - Corporate BankingBank of Baroda - Retail BankingBank of IndiaBank of MaharashtraCanara BankCentral Bank of IndiaCity Union BankCorporation BankDeutsche BankDevelopment Credit BankDhanlaxmi BankFederal BankICICI BankIDBI BankIndian BankIndian Overseas BankIndusInd BankING Vysya BankJammu and Kashmir BankKarnataka Bank LtdKarur Vysya BankKotak BankLaxmi Vilas BankOriental Bank of CommercePunjab National Bank - Corporate BankingPunjab National Bank - Retail BankingPunjab & Sind BankShamrao Vitthal Co-operative BankSouth Indian BankState Bank of Bikaner & JaipurState Bank of HyderabadState Bank of IndiaState Bank of MysoreState Bank of PatialaState Bank of TravancoreSyndicate BankTamilnad Mercantile Bank Ltd.UCO BankUnion Bank of IndiaUnited Bank of IndiaVijaya BankYes Bank LtdNot Applicable

14.Choose Your Gramin Bank(optional)
Select OneAndhra Pradesh Grameena Vikas BankAndhra Pragathi Grameena BankArunachal Pradesh Rural BankAryavart BankAssam Gramin Vikash BankBangiya Gramin Vikash BankBaroda Gujarat Gramin BankBaroda Rajasthan Kshetriya Gramin BankBaroda UP BankChaitanya Godavari Grameena BankChhattisgarh Rajya Gramin BankDakshin Bihar Gramin BankEllaquai Dehati BankHimachal Pradesh Gramin BankJ&K Grameen BankJharkhand Rajya Gramin BankKarnataka Gramin BankKarnataka Vikas Grameena BankKerala Gramin BankMadhya Pradesh Gramin BankMadhyanchal Gramin BankMaharashtra Gramin BankManipur Rural BankMeghalaya Rural BankMizoram Rural BankNagaland Rural BankOdisha Gramya BankPaschim Banga Gramin BankPrathama UP Gramin BankPuduvai Bharthiar Grama BankPunjab Gramin BankRajasthan Marudhara Gramin BankSaptagiri Grameena BankSarva Haryana Gramin BankSaurashtra Gramin BankTamil Nadu Grama BankTelangana Grameena BankTripura Gramin BankUtkal Grameen BankUttar Banga Kshetriya Gramin BankUttar Bihar Gramin BankUttarakhand Gramin BankVidharbha Konkan Gramin BankNot Applicable

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) *
—Please choose an option—Select OneAndaman and Nicobar Islands (union territory)Andhra PradeshArunachal PradeshAssamBiharChandigarh (union territory)ChhattisgarhDadra and Nagar Haveli (union territory)Daman and Diu (union territory)Delhi (national capital territory)GoaGujaratHaryanaHimachal PradeshJammu and Kashmir (union territory)JharkhandKarnatakaKeralaLadakh (union territory)Madhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherry (union territory)PunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal

22.Select your School City (PASSED) *
Select OnePort BlairAdoniAmaravatiAnantapurChandragiriChittoorDowlaiswaramEluruGunturKadapaKakinadaKurnoolMachilipatnamNagarjunakoṇḍaRajahmundrySrikakulamTirupatiVijayawadaVisakhapatnamVizianagaramYemmiganurItanagarAdoniAmaravatiAnantapurChandragiriChittoorDowlaiswaramEluruGunturKadapaKakinadaKurnoolMachilipatnamNagarjunakoṇḍaRajahmundrySrikakulamTirupatiVijayawadaVisakhapatnamVizianagaramYemmiganurItanagarDhuburiDibrugarhDispurGuwahatiJorhatNagaonSibsagarSilcharTezpurTinsukiaAraBaruniBegusaraiBettiahBhagalpurBihar SharifBodh GayaBuxarChapraDarbhangaDehriDinapur NizamatGayaHajipurJamalpurKatiharMadhubaniMotihariMungerMuzaffarpurPatnaPurniaPusaSaharsaSamastipurSasaramSitamarhiSiwanAmbikapurBhilaiBilaspurDhamtariDurgJagdalpurRaipurRajnandgaonSilvassaDamanDiuDelhiNew DelhiMadgaonPanajiAhmadabadAmreliBharuchBhavnagarBhujDwarkaGandhinagarGodhraJamnagarJunagadhKandlaKhambhatKhedaMahesanaMorviNadiadNavsariOkhaPalanpurPatanPorbandarRajkotSuratSurendranagarValsadVeravalAmbalaBhiwaniChandigarhFaridabadFirozpur JhirkaGurgaonHansiHisarJindKaithalKarnalKurukshetraPanipatPehowaRewariRohtakSirsaSonipatBilaspurChambaDalhousieDharmshalaHamirpurKangraKulluMandiNahanShimlaUnaAnantnagBaramulaDodaGulmargJammuKathuaPunchRajauriSrinagarUdhampurBokaroChaibasaDeogharDhanbadDumkaGiridihHazaribagJamshedpurJhariaRajmahalRanchiSaraikelaBadamiBallariBangaloreBelgaviBhadravatiBidarChikkamagaluruChitradurgaDavangereHalebidHassanHubballi-DharwadKalaburagiKolarMadikeriMandyaMangaluruMysuruRaichurShivamoggaShravanabelagolaShrirangapattanaTumkuruAlappuzhaBadagaraIdukkiKannurKochiKollamKottayamKozhikodeMattancheriPalakkadThalasseryThiruvananthapuramThrissurBalaghatBarwaniBetulBharhutBhindBhojpurBhopalBurhanpurChhatarpurChhindwaraDamohDatiaDewasDharGunaGwaliorHoshangabadIndoreItarsiJabalpurJhabuaKhajurahoKhandwaKhargonMaheshwarMandlaMandsaurMhowMorenaMurwaraNarsimhapurNarsinghgarhNarwarNeemuchNowgongOrchhaPannaRaisenRajgarhRatlamRewaSagarSarangpurSatnaSehoreSeoniShahdolShajapurSheopurShivpuriUjjainVidishaAhmadnagarAkolaAmravatiAurangabadBhandaraBhusawalBidBuldanaChandrapurDaulatabadDhuleJalgaonKalyanKarliKolhapurMahabaleshwarMalegaonMatheranMumbaiNagpurNandedNashikOsmanabadPandharpurParbhaniPuneRatnagiriSangliSataraSevagramSolapurThaneUlhasnagarVasai-VirarWardhaYavatmalImphalCherrapunjiShillongAizawlLungleiKohimaMonPhekWokhaZunhebotoBalangirBaleshwarBaripadaBhubaneshwarBrahmapurCuttackDhenkanalKeonjharKonarkKoraputParadipPhulabaniPuriSambalpurUdayagiriKaraikalMahePuducherryYanamAmritsarBatalaChandigarhFaridkotFirozpurGurdaspurHoshiarpurJalandharKapurthalaLudhianaNabhaPatialaRupnagarSangrurAbuAjmerAlwarAmerBarmerBeawarBharatpurBhilwaraBikanerBundiChittaurgarhChuruDhaulpurDungarpurGanganagarHanumangarhJaipurJaisalmerJalorJhalawarJhunjhunuJodhpurKishangarhKotaMertaNagaurNathdwaraPaliPhalodiPushkarSawai MadhopurShahpuraSikarSirohiTonkUdaipurGangtokGyalsingLachungManganArcotChengalpattuChennaiChidambaramCoimbatoreCuddaloreDharmapuriDindigulErodeKanchipuramKanniyakumariKodaikanalKumbakonamMaduraiMamallapuramNagappattinamNagercoilPalayankottaiPudukkottaiRajapalaiyamRamanathapuramSalemThanjavurTiruchchirappalliTirunelveliTiruppurTuticorinUdhagamandalamVelloreHyderabadKarimnagarKhammamMahbubnagarNizamabadSangareddiWarangalAgartalaAgraAligarhAmrohaAyodhyaAzamgarhBahraichBalliaBandaBara BankiBareillyBastiBijnorBithurBudaunBulandshahrDeoriaEtahEtawahFaizabadFarrukhabad-cum-FatehgarhFatehpurFatehpur SikriGhaziabadGhazipurGondaGorakhpurHamirpurHardoiHathrasJalaunJaunpurJhansiKannaujKanpurLakhimpurLalitpurLucknowMainpuriMathuraMeerutMirzapur-VindhyachalMoradabadMuzaffarnagarPartapgarhPilibhitPrayagrajRae BareliRampurSaharanpurSambhalShahjahanpurSitapurSultanpurTehriVaranasiAlmoraDehra DunHaridwarMussoorieNainitalPithoragarhAliporeAlipur DuarAsansolBaharampurBallyBalurghatBankuraBaranagarBarasatBarrackporeBasirhatBhatparaBishnupurBudge BudgeBurdwanChandernagoreDarjilingDiamond HarbourDum DumDurgapurHalisaharHaoraHugliIngraj BazarJalpaiguriKalimpongKamarhatiKanchraparaKharagpurKoch BiharKolkataKrishnanagarMaldaMidnaporeMurshidabadNavadwipPalashiPanihatiPuruliaRaiganjSantipurShantiniketanShrirampurSiliguriSiuriTamlukTitagarhOthers Cities

[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) *
—Please choose an option—Select OneSelect OneAndaman and Nicobar Islands (union territory)Andhra PradeshArunachal PradeshAssamBiharChandigarh (union territory)ChhattisgarhDadra and Nagar Haveli (union territory)Daman and Diu (union territory)Delhi (national capital territory)GoaGujaratHaryanaHimachal PradeshJammu and Kashmir (union territory)JharkhandKarnatakaKeralaLadakh (union territory)Madhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherry (union territory)PunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal

28.Select your School Cities (PRESENTLY PURSUING) *
—Please choose an option—Select OnePort BlairAdoniAmaravatiAnantapurChandragiriChittoorDowlaiswaramEluruGunturKadapaKakinadaKurnoolMachilipatnamNagarjunakoṇḍaRajahmundrySrikakulamTirupatiVijayawadaVisakhapatnamVizianagaramYemmiganurItanagarAdoniAmaravatiAnantapurChandragiriChittoorDowlaiswaramEluruGunturKadapaKakinadaKurnoolMachilipatnamNagarjunakoṇḍaRajahmundrySrikakulamTirupatiVijayawadaVisakhapatnamVizianagaramYemmiganurItanagarDhuburiDibrugarhDispurGuwahatiJorhatNagaonSibsagarSilcharTezpurTinsukiaAraBaruniBegusaraiBettiahBhagalpurBihar SharifBodh GayaBuxarChapraDarbhangaDehriDinapur NizamatGayaHajipurJamalpurKatiharMadhubaniMotihariMungerMuzaffarpurPatnaPurniaPusaSaharsaSamastipurSasaramSitamarhiSiwanAmbikapurBhilaiBilaspurDhamtariDurgJagdalpurRaipurRajnandgaonSilvassaDamanDiuDelhiNew DelhiMadgaonPanajiAhmadabadAmreliBharuchBhavnagarBhujDwarkaGandhinagarGodhraJamnagarJunagadhKandlaKhambhatKhedaMahesanaMorviNadiadNavsariOkhaPalanpurPatanPorbandarRajkotSuratSurendranagarValsadVeravalAmbalaBhiwaniChandigarhFaridabadFirozpur JhirkaGurgaonHansiHisarJindKaithalKarnalKurukshetraPanipatPehowaRewariRohtakSirsaSonipatBilaspurChambaDalhousieDharmshalaHamirpurKangraKulluMandiNahanShimlaUnaAnantnagBaramulaDodaGulmargJammuKathuaPunchRajauriSrinagarUdhampurBokaroChaibasaDeogharDhanbadDumkaGiridihHazaribagJamshedpurJhariaRajmahalRanchiSaraikelaBadamiBallariBangaloreBelgaviBhadravatiBidarChikkamagaluruChitradurgaDavangereHalebidHassanHubballi-DharwadKalaburagiKolarMadikeriMandyaMangaluruMysuruRaichurShivamoggaShravanabelagolaShrirangapattanaTumkuruAlappuzhaBadagaraIdukkiKannurKochiKollamKottayamKozhikodeMattancheriPalakkadThalasseryThiruvananthapuramThrissurBalaghatBarwaniBetulBharhutBhindBhojpurBhopalBurhanpurChhatarpurChhindwaraDamohDatiaDewasDharGunaGwaliorHoshangabadIndoreItarsiJabalpurJhabuaKhajurahoKhandwaKhargonMaheshwarMandlaMandsaurMhowMorenaMurwaraNarsimhapurNarsinghgarhNarwarNeemuchNowgongOrchhaPannaRaisenRajgarhRatlamRewaSagarSarangpurSatnaSehoreSeoniShahdolShajapurSheopurShivpuriUjjainVidishaAhmadnagarAkolaAmravatiAurangabadBhandaraBhusawalBidBuldanaChandrapurDaulatabadDhuleJalgaonKalyanKarliKolhapurMahabaleshwarMalegaonMatheranMumbaiNagpurNandedNashikOsmanabadPandharpurParbhaniPuneRatnagiriSangliSataraSevagramSolapurThaneUlhasnagarVasai-VirarWardhaYavatmalImphalCherrapunjiShillongAizawlLungleiKohimaMonPhekWokhaZunhebotoBalangirBaleshwarBaripadaBhubaneshwarBrahmapurCuttackDhenkanalKeonjharKonarkKoraputParadipPhulabaniPuriSambalpurUdayagiriKaraikalMahePuducherryYanamAmritsarBatalaChandigarhFaridkotFirozpurGurdaspurHoshiarpurJalandharKapurthalaLudhianaNabhaPatialaRupnagarSangrurAbuAjmerAlwarAmerBarmerBeawarBharatpurBhilwaraBikanerBundiChittaurgarhChuruDhaulpurDungarpurGanganagarHanumangarhJaipurJaisalmerJalorJhalawarJhunjhunuJodhpurKishangarhKotaMertaNagaurNathdwaraPaliPhalodiPushkarSawai MadhopurShahpuraSikarSirohiTonkUdaipurGangtokGyalsingLachungManganArcotChengalpattuChennaiChidambaramCoimbatoreCuddaloreDharmapuriDindigulErodeKanchipuramKanniyakumariKodaikanalKumbakonamMaduraiMamallapuramNagappattinamNagercoilPalayankottaiPudukkottaiRajapalaiyamRamanathapuramSalemThanjavurTiruchchirappalliTirunelveliTiruppurTuticorinUdhagamandalamVelloreHyderabadKarimnagarKhammamMahbubnagarNizamabadSangareddiWarangalAgartalaAgraAligarhAmrohaAyodhyaAzamgarhBahraichBalliaBandaBara BankiBareillyBastiBijnorBithurBudaunBulandshahrDeoriaEtahEtawahFaizabadFarrukhabad-cum-FatehgarhFatehpurFatehpur SikriGhaziabadGhazipurGondaGorakhpurHamirpurHardoiHathrasJalaunJaunpurJhansiKannaujKanpurLakhimpurLalitpurLucknowMainpuriMathuraMeerutMirzapur-VindhyachalMoradabadMuzaffarnagarPartapgarhPilibhitPrayagrajRae BareliRampurSaharanpurSambhalShahjahanpurSitapurSultanpurTehriVaranasiAlmoraDehra DunHaridwarMussoorieNainitalPithoragarhAliporeAlipur DuarAsansolBaharampurBallyBalurghatBankuraBaranagarBarasatBarrackporeBasirhatBhatparaBishnupurBudge BudgeBurdwanChandernagoreDarjilingDiamond HarbourDum DumDurgapurHalisaharHaoraHugliIngraj BazarJalpaiguriKalimpongKamarhatiKanchraparaKharagpurKoch BiharKolkataKrishnanagarMaldaMidnaporeMurshidabadNavadwipPalashiPanihatiPuruliaRaiganjSantipurShantiniketanShrirampurSiliguriSiuriTamlukTitagarhOthers Cities

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


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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