AUp.74 & 75 sUper@ ore GOVERNMENT OF TAMIL NADU AAS MOL A jig inpringyqudleort evs sien * ADI DRAVIDAR AND TRIBAL WELFARE DEPARTMENT Post Matric Scholarship Renewal Form / Gursiut Gut fé soa) 2 ails Opens é Ug se Lipo Algitungy osied ullgyih wdaiiureder(y Academic Year | Biyhogu sdeurcnya unemra5Go5 Dospomund auptacuc gatligs eit G act (Scholarship Student ID) 7 Cluiegus esisfunsinges wien 656 cupric. Gy Sy eres (Exam Register Number 1 [et Posie Cugh 56 GYymmne (ysexud/Institution Name & Address ‘sebel Henna gs Clan maxed ester, 1)Phone Number of the institution 2)Mobile Number of the person dealing with | Scholarship subject aiid Senaws Siar Denergoe ypsnu e-mail id of the Institution iremauticremall Gut 7 Students Name 3 | Quik 7 Gender asin Aveta laasnpominineSemb/Male/Remale | [Transgender 4 | engi allem / Community Details (2) ue gus Qingieseni (SC) (6) Uphasyguen(ST) (MMe UEsADG njfu L'pusd Gord ges Scheduled Caste Converted to Christianity (seq) ang) a. Gifieien Quaid /Sub casie Name 50/6 ay B45 748 75~3.78 300Co8 =7010— a 8 as em1) Sinan (pawufl/ Permanent Address Iphone yao /Temporary Address ] Comecorsaflecr oy sit ereer Student Aadhaar Number anreaarsufleer CigsreneuGue steer ‘Student Phone Number oncom aufero ae) epescutl Student e-mail ID um (afifisiletr Ghaust /Subject Name 10 | uidlgyit 5b / Stdying year we ( V) @oummyd) a)second year O b)Third year a) | e}Fifth year O d)Sixth year C 12 Lig SaSThaetTyw onewat aloe Coie sist/Date in which the applicant joined the class in current year laters Uahensu sein) Guiin axgene HgserO Last year student attendance Percentage 13 | Giergu odstinatipa gen Glip Sener Bg Gainyssoerup’ wovsoneut siegGuicierm? Whether the student has written all exams in th previous year. tod Gaiey austen acid 3 epener sajomh @Ldheaw ofildms sefd masenud ensing, Qeosmgyisnnn ? If the student has not written any exam, state the reason (If not well, medical certificate has been submitted (or) not? ia 15 oneneraut SON rhidl aSleunat (a) HHO BW sihusngy LiSouest _Hosteller (or) Day Schollar Tustenneut aGIEUED gel LuSousaT eel, SSO Pui Qui / Where the applicant is | residing in the Hostel name Bie asin OSU Canis prs Date on which the applicant joined the Hostel Current year T]aSG Sl anda FeonnBan oh Gwowarbaicioran? Where the hostel is attached to the institution?3 4) patuni AOS aad sig) aad Haare semasns syvSesAbacs’ gn? If private Hostel whether it is recognized by education institution Head. SjqmdaMsaiucr gecfumt HGH srefidd ( 2 sverey wwf a smmpeSLns ese eCLemia ageléacu@slngn? If recognized private Hostel whether Fees collected for food & Accommodation ] Oakéelssuc safuni aod safia, @ensurs — 2.0ma, wim = emai augrislu@singn Recognized private Hostel whether food & Accommodation free) 16 p76 AAG Pin? gph wha, Mages gefseays Whether the student is staying in the Govt. Hostel.If so, indeicate details there for. JASE F pas gp AGS Adi-Dravidar Welfare Department Hostel ASH Co novsgene ONS Backward Class Welfare Department Hostel Filan OOS Cou Cnt wid Ag aterm Seer mason) 80) / Most Backward Class and 4)Ban HO Hert @pH4_ayh | Other hostels please cate 17 AGBHS eninenflar Gut Liga naGhursub/ Hostel warden Name and Signature 18 LOY ScheRlureterad Corio (pga UTED WL auguii/Current Academic year exam close month and yeu 19 aires a amerupimasn? ou cof, GungEssionersuheom ¥& whether the applicant of physically disabled If yes, tick (\ ) the suitable. (9) | unison @emmay/ Low Vision (@p [engi GeCudis eamustenant / Deak @) | Gong Gandia Goel arash [Recovered from leprosy © | wergpnurs ungtuco. feasted / Psychologically affected C) | me. ordedh saan yigy aplSgimeurontartcr esol dr acdgrlé™ Gedunut | Orthopedically handicapped gring to college with the help of an ee) | m6, arse een SdgTf_e Gerke asia arudiuSlg’umsiasir / Physically handidcapped students staying in hostels attached to the Institution.4 Guguunutest/ Special coaching for mentally retarded ©) | Gamat asriddl Ge TumiogsSaren And aap person. ore sui ungMiSearTed 2b aorsmyyiyneut ersngy reenreat cosognfiuscir Glenseigs AMOI gi Mont / exdsenoomunert 2 seSluer svgunfiéxes aigs Getdgri | cpmer series Gmnpouiaenderen Jigly USA Cuyunst nenpLh enénnahlsderGosn. arfly onsigyesi Geneon desl @ efurisaiiu gp Certified that the students .. ee ...Gefect is physically challenged and is studying in the institution as hosteller attached to the institution coming to institution with the help of a give / receiving special training for mentally retarded person. Due certificate re enclosed and verified. 20 |orseeues aud aaeré6 of ‘Student Bank Account Details innecsrenfesr eure esreerd@ creer. Student Bank Account Number 1 | suid Quit 7 Bank Name 2. | eutidl disor / Bank Branch 3] MICR Code / MICR @aut® L a IFSC Code / IFSC efuiiy 21 | Yhegu stciinah Gach uremndéat ulern agiueete | Gotay sie spshiMgnms si deniendy sSiorseriugy sin 2 aeSQanema Osman 7 (gd sof) Semper Utd Be 2 geSGeTeNG AASDer Sp Cupp adel 2 s0H5Gormaullmsr onad | srmbdd soiu Aepss, Gopsgid dysir poo Geremsacu Gasin@id Whether the applicant is in | receipt of more than two scholarship including this onc? If yes, ie should return the scholarship to Govt., which is less beneficial to him as per his choice and chellan copy should be enclosed. B) Ge pegBE pee air eta aor Challen Number and Date 22 | ply oaslininph ueamdat Gunta GutMeasbed | 2pAab@pneme GCL gers sh Gen sae! asshiiAgnos | ACLmwsofer Sp uuu aBleineeniMigucrsmm? aya | cafes 2508 aSismaWhether the student has applied for any other scholarship scheme other than this scheme? If, yes provide the details of the scheme.5 Larseraufler 2 gy SiGe p) - DECLARATION OF STUDENT 1) BMiaieoeriuips ePARtucOeon geerdg) aarioend efunorees wgth asirsnouneiea cer a ppuale Gut, siren seficcucr apesn slemtiad Acrometes Seg) Fm dei HULL ne ede GURhBSlUC adie 2 peibAgnsom yRgaNmsind 70 aud og sasldignd Sepi8 gifs Gemediner nso womany 2 gS gflés\encn. | here by declare that all the details submitted application are correct and true. If any of the details submitted is found to be incorrect later, then I hereby give my consent to return the scholarship to cbed sanctioned to government in any means prescribed by the government nis) Ben 2) Bit) adeduneinyd Gurdn” Gio Md asbe9 a gnlbUgneradeid al 2b6 | urbe ona adie! agoNSCpnme DAikwaher Sed uuMdOyy AernioeisGide, SrDkS Cub Aids 8) wusiCun oneméat Carin, Guys CKle imewrdengy SOUstionovieney Emme wir sg Sc Lruseher dp CupinGrs AsuseSenw nad ound do BGNSS Qesyie eo SwahéAtndrin the event that fT had / have applied for Post-matric scholarship and any other schemes of Central / State Govt. in current year / previous year and if the student is sclected for the award of scholarship in more than one scheme then I here by given my consent to return the scholarships under the schemes to Government as per my choice . Student Signature, DECLARATION OF HEAD OF THE INSTITUTION Juremast ese apa sAgrms Gyo Cnggner ages sSegienG) Guiyyérerni nen aneopehéSiGner. Certified that, the student’ has secured requisite percentage of attendance for sanction of scholarship 2unemeded sAeinseniug Od GAIL erurtiac inigyh sins, sybumeTissmar 2yiiay Sasopsit o¢p!neo.uS> Graoromréeesie; Gunn’ Qu NS ainS « gasGsrons HL shir di oti sents Gena un se) anifise seer srhmahédltnsn. gaynrar sfnmoch culties! Seer sen uitind ping _luMeaLGd sda sxdas, estes EMME sTEse shiaGgrd uewrdoNUGESs UB Gail) onad send AHeyi0s Gosudp 2oxSwefésiGps. The details submitted by the student in his application are verified and post matric scholarship has been claimed based on those verified Gtails. IF it is found that scholarship has been claimed by institution by submitting incorrect data, scholarship obtained so will be returned to government account in the manner as prescribed by the government 3} py) sdefurcinyd unemnéat Gundv. Gul ade agcdSdanmadeid Heinen iSiey Cagy sein apchisOanems Di ihusafir Sp uuu Pein slasher, BEA Ser Sh ween nomndet Gaia, Qugasniter unamnéad aliens, Cenarer wLaEGh AL Pk Sp Aum Gh MEwseilon rsrdenfh Mesa: vps Aarts OES asmbde MGs Coyss amGuhé&Cnar. If ths student is in receipt of Scholarship under more than one Scheme in the previous year than challan copy for the remittance of scholarship received under the scheme where the benefit is less as per the choice exercised by the student to the government Place: Principal Signature with Seal Date:6 oflumivny Ur pus (CHECK LIST OQmamsoiu Cosinpu gurcortiesetlr Gaumnnewyiey o1VOy 9 cher oc sud V pss Gedung) 1S Queter ansirgyerr 2nd) somdre Yip WOH Use ned Mark Certificate C) Bank Pass Book First Page Copy 3 axgenend ensingy oes Attendance Original Certificate C) 4. heron gusty gernde; Cup BLL iwathin Bj ssdo8 a gehigrons Quin Sime Gonaner wwsCupd Pigser &> Gumi. sdell CJ spAléGormu 2156 S58 Dogri Susiener denies H G pe. If ths student is in receipt of Scholarship under more than one Scheme in the previous year than challan copy for the remittance of scholarship received under the scheme where the benefit is less as per the choice exercised by the student to the government, pigs 5 Se UMgyd wremrésiseree wl Ob GPily = (1) gihawig oxi» puIBpnere GeioseniusAeme P5geomund sree wed usta Faseymféig augriscu Biewseorw suyfl uwert wus (Login 1D) epeud Glenceorus Lucu UPCahnd Orig) aoAMBoiUMNE. y6amy afl onmssld gaiiad LAS Lsrefl | adem ewaune shams) asiromiuyislnsn Genser axpuiler AGryiyrd Geriiareer phe SAe0n seclie go oeoLumer wFul\G suey (Scholarship Student ID) nipieiiOd gesis urac gH wind upset ow seyRK' wbx Gam iyo gyn genwetedt ufligiconilsr gigi Wed uemréeieeneLu extié) serd8ids 509 2 ge9505TOG eunay omdolUND. (2) unommdeiesr grsemgy Student id gpord asda o pelsAgnme aeiersnmigs Beh sre a onusnest pi) Aeer oily Genserusen wpsrsl apo gyfibs) Gandrercumb. oe Be e 3) Qmemupeypssufl: htips://cdeptadwscholarship.tn.gov.in/edst_adw/