9/14/2016 MCM Scholarship

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Indian Institute of Technology Indore

Application for the Fresh MCM Scholarship and Remission of Tuition Fee
Scholarship Applying: Fresh Academic Year: 2016
Roll No.: 160004039 Name: SUMIT MEENA
Department: Civil Engineering Program: B.Tech.
Name of Father: Rajveer Meena ( Father ) Category: st
Hostel Address: room no. 1, D613
Mobile No.: 8827831289 Email ID: deshrajmna222@gmail.com
Any other Scholarship: no Parental Income 519297
Year of qualifying JEE (Advanced) / JAM : 2016
All India Rank (AIR) rank in JEE (Advance) / JAM : 354
Bank Details :
Name of Bank: Bank of Baroda
Branch Address: Station road , Near Natraj cinema, kota , Rajasthan
Account No.: 42660100003614 IFCS Code: BARB0STAKOT
DECLARATION
I SUMIT MEENA Roll No. 160004039 hereby declare that I am not in receipt of any
Scholarship/Stipend/Financial Assistance. In case I am awarded any scholarship/stipend etc. in
future, I shall intimate the same to the Institute and shall refund the entire amount of the Institute
scholarship received by me, before receiving the other scholarship / stipend etc. for the year. A
copy
of latest Income Tax Return / Income certificate (in original) of my parents is attached.
Date: September 14, 2016 (Signature of Applicant)
Full Name: SUMIT MEENA
Enclosures :
1. Parental Income Certificate in Attested or original.
2. Certificate of Rank in JEE (Advanced) / JAM.
3. Bank Pass Book (Photocopy for account details).