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INDIAN INSTITUTE OF TECHNOLOGY DELHI

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HAUZ KHAS, NEW DELHI-ll0016

~ ~/SCHOLARSHIPFORM
~~/INSTRuenONs:

(1)

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The receipients of Institute S/ship and others are required to
furnish prereceipt No. I only duly stamped, in other cases for
Book grant pre-receiPt (No.1 and 2) duly-stamped would be
necessary.

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(2)

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In case this claim alongwith pre-receipts(s) is/are desired to be

deposited in the Accounts Section, please get your signature
attested by the Head of your Depaltment or his nominee.
(3)

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Please write your Bank Account Number Correctly.

(TO BE FILLED IN BY THE STUDENT).

_ _ _ _ _ _llm cff ~ 3lftrl ~ ~ ~ ~ lli'T
CLAIM AND PRE-RECEIPT OF SCHOLARSHIP FOR THE MONTH OF

Q)[ "fTll/Name of the Scholarship

_
"fTll/Name of the Student.
,----_ _.
~ 'Xffim/Entry No.
_
Ffl(fCl) /MldCl1'i"d'(/mu ~/UGIPG/R. Scholar
_
fct1WT Cf>l "'!'A/Name of Department
_
&rill x:Rim/Bank A/e No. (1) ~n.m if'cfJ, ~.3f~.tt.~/SBl, LI.T. Delhi
_
(2) cf;;ru tiP, 3rrt.~.tt.~/Canara Bank, lIT, Dehi- - - wnfUru fcnm \JlTffi ~ fcp lj-;f ftRr 3fClfu cf; fc;r~ u~~ ctt llTTT c6t t. \Rf 3lCTft -q fcr~lfll/Cf1m3l1 -q

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WCertified that I have attended the Department/Classes regularly

during the period for which the scholarship is claimed herewith.

~/Date

Xi <:"lll fq d/VERIFIED

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Signature of Student
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Sig. Supvr. ( for Res. Sch)

Prog, Coord (for M. Tech Student)

Course Coord/H.p.D. (for B. Tech.)

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3rn11 ~ 1/Pre-Receipt 1
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be filled in by 1.1.1'. S/ship Claimant and others.)

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Received the sum ofRs.

(Rupeeso
_
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _only) from the Registrar, 1.1.1'. Delhi
towards my scholership for the month of'
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Signature of the Student on Revenue Stamp

"'l11l/Name _--'---~

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Signature of the Student attested

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x=mm/Entry No.o

rnfi1ctt/Head of Deptt.lhis nominee

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Gross Amount of the S/ship to be filled in

3Tfirif WtG 2/Prc-Receipt 2

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be filled in by other than 1.1.T. S/ship Claimant)

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Received the sum of .
(Rupees
only) from the
Registrar. I.I.T. Delhi towards my NCERT/State/Central/CBSE/ICAR/ICSSR/Other Agency/S/ship
Book Grant for the monthlyear
_

~/Date

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Signature of the Student on Revenue Stamp

";fill/Name - - - - - - - - - - - - - ~ x=mm/Entry No.

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ffl"'lflTf/Department
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Gross Amount of the S/ship to be filled in