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CM Balochistan Form Scholarship

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Special Support Program (SSP) Social Welfare Department

Application Form for Secondary & Higher Secondary students through


Education Department

Block No.2 Room No.24, 1st Floor, Secondary Education Department, Ph # 081-9204227
1. School/Institute Name:
2. (i).Degree & Subject: (ii). Present Semester or Year:
Marks GPA
(iii). Detail of Obtained Marks/GPA: Total Obtained Overall %age Total Obtained Overall %age

3. (i). Student Name: (ii).Student’s CNIC: (Enclose Photocopy)


(Only less than 18 years, enclose form B)
(iii). Roll No: (iv). Registration No:
(v). Father/Mother/Guardian Name: (vi).CNIC:
(vii).Father/Mother/Guardian Occupation:
(viii). Home Address: ( ix) Contact No,

Sr # Particulars/Expenses. Amount (Rs.) Remarks


1 Admission fee
2 Monthly Tuition fee

Total Amount (in figures): (in words):


4. (i). It is certified that above dues are liable to be paid by the student.
(ii). It is verified that information provided above is correct. In case of any mis-statement/mis-declaration, the
institution will be liable to refund the amount to Government of Balochistan at any stage.

HEAD OF INSTITUTION
Name and Signature with Stamp

(Only for Student Residing in schools Hostel)


5. The Above named student is residing in Room No. of Hostel since .
His / Her hostel dues (excluding meal charges) per month are Rs. (in-words)
.

HOSTEL WARDEN (CONCERNED)


Name and Signature with Stamp
CERTIFICATE
It is certified that the occupation of above named student’s Father/Mother/Guardian is
_____________________________ and his/her monthly income is Rs.______________ per month.

Deputy Director/Social Welfare officer


(concerned District)
Name and Signature with Stamp

1. Amount requested by the applicant


2. Amount recommended by the Committee
3. Amount sanctioned by the competent authority

It is solemnly affirmed that the above information is based on true statement and nothing is concealed therein.
I further undertake that I am not beneficiary of such grant in past.
Date: _______________ ____ Name and Signature of the applicant: ________________

Recommendation of the committee for Grant aid (SSP).


It is stated that the case of Student Mr./Mrs.________________________ is recommended for the approval on
the basis that he/she is unable to bear Educational expenses.

Signature with stamp of committee chairman Education


Department (SSP) Balochistan

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