Scholarship Application Form Page 3
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2
3Hostel Details
Name of the Hostel
Hostel Admission Date
Hostel Type
Is Mess Service Available
YES / NO
Rent per Month
Hostel Address
Pin-code
Taluka
District
Hostel Contact Details
Telephone Number
Mobile Number
Email Address
Documents
Caste Certificate Number
Issuing Office
Caste Validity Certificate Number
Scrutiny Committee
Income Certificate Number
Date of Issue
University Registration Number
DECLARATION
The information furnished by me is complete and correct. I bear the complete responsibility for all the
above information provided.
Applicant’s Signature
Parent’s Signature
Principal’s Signature
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