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    Indian Institute of Technology Kanpur Senate Scholarships and Prizes Committee Application Form For Free-Basic-Mess (FBM) Scholarship

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    Mukul Chandra
    Mukul Chandra, a student from the Department of Mechanical Engineering at IIT Kanpur, has applied for a Free Basic Mess (FBM) scholarship. He is an SC category student in the B-Tech program with an annual family income below the threshold. In the application, he provides personal details like contact information and parental occupation/income details. He also declares that he is not currently receiving any other scholarship. By signing the undertaking, he agrees that any incorrect or false information provided could result in actions taken by IIT Kanpur per their ordinances.

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    © All Rights Reserved
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    Indian Institute of Technology Kanpur Senate Scholarships and Prizes Committee Application Form For Free-Basic-Mess (FBM) Scholarship

    Uploaded by

    Mukul Chandra
    43 views2 pages
    Mukul Chandra, a student from the Department of Mechanical Engineering at IIT Kanpur, has applied for a Free Basic Mess (FBM) scholarship. He is an SC category student in the B-Tech program with an annual family income below the threshold. In the application, he provides personal details like contact information and parental occupation/income details. He also declares that he is not currently receiving any other scholarship. By signing the undertaking, he agrees that any incorrect or false information provided could result in actions taken by IIT Kanpur per their ordinances.

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    FBM

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    Mukul Chandra, a student from the Department of Mechanical Engineering at IIT Kanpur, has applied for a Free Basic Mess (FBM) scholarship. He is an SC category student in the B-Tech program with an annual family income below the threshold. In the application, he provides personal details like contact information and parental occupation/income details. He also declares that he is not currently receiving any other scholarship. By signing the undertaking, he agrees that any incorrect or false information provided could result in actions taken by IIT Kanpur per their ordinances.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    43 views2 pages

    Indian Institute of Technology Kanpur Senate Scholarships and Prizes Committee Application Form For Free-Basic-Mess (FBM) Scholarship

    Uploaded by

    Mukul Chandra
    Mukul Chandra, a student from the Department of Mechanical Engineering at IIT Kanpur, has applied for a Free Basic Mess (FBM) scholarship. He is an SC category student in the B-Tech program with an annual family income below the threshold. In the application, he provides personal details like contact information and parental occupation/income details. He also declares that he is not currently receiving any other scholarship. By signing the undertaking, he agrees that any incorrect or false information provided could result in actions taken by IIT Kanpur per their ordinances.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    INDIAN INSTITUTE OF TECHNOLOGY KANPUR

    Senate Scholarships and Prizes Committee

    Application Form for


    Free-Basic-Mess (FBM) Scholarship

    1. Name of the Student: Mukul chandra 2. Roll No.: 160421

    3. Programme.: B-Tech 4. Department.: Mechanical engineering

    5.Category: (SC or ST) – SC 6. Home Phone:

    Mobile No: 9456554737

    7. E-mail-ID: mukulc@iitk.ac.in 8. Address: Hall 3 A/103

    9. Parental Details: (Occupation may be Govt. Job/Private Job/Business/Agriculture/ Other-


    please specify the occupation if other e.g. doctor, lawyer, teacher, etc.)

    Father/Guardian Details Mother/Guardian Details


    Name: Name:
    Chandra Prakash Janki Arya
    Occupation: Occupation:
    Government service Housewife
    PAN No.: PAN No.:

    Annual Income: Annual Income:

    Mobile No.: 945665437 Mobile No.: 9456554737


    Total Family Annual Income (TFAI):

    10. Proof of income attached (tick one or both):


    A.) ITR-Vs
    B.) Form -16
    C.) Certificate from Govt. Official.

    Page | 1
    INDIAN INSTITUTE OF TECHNOLOGY KANPUR
    Senate Scholarships and Prizes Committee

    Application Form for


    Free-Basic-Mess (FBM) Scholarship

    11. Other Scholarship Details (attach documents):

    Are you currently receiving any scholarship


    from IIT Kanpur or external sources (Yes/No):
    NO
    If yes, provide details (Name of Scholarship,
    Amount, Agency, etc.)

    12. You must sign the following declaration/undertaking.

    UNDERTAKING

    a) I hereby undertake and certify that the information provided in this form is correct and true to
    the best of my knowledge and belief and nothing material has been concealed. I understand that
    in the event of any information being found false, misleading or incorrect, or ineligibility to
    receive the FBM Scholarship is detected during or after completion of my programme at IIT
    Kanpur, or any of the personal information furnished in support thereof is found incorrect,
    neither I nor my parents/guardian shall have any objection whatsoever against the actions taken
    by the IIT Kanpur in the matter, in accordance with provisions 9.3 and 12.2 of the Ordinance of
    the IIT Kanpur.

    b) I further declare that I am not receiving any scholarship either from IIT Kanpur or from any
    other external agency during the academic year 2018-19.

    ________________
    Student’s Signature

    Date:

    Page | 2

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