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Enclosure I

Letter dt. ……/……………/ 2010


(To Be Filled By Institution/ Student and Dully Certified By Institution )
Affix Passport Size
NOTE: Please fill in the information in capital letters Recent Photo of
Candidate duly
1. Registration No. : ……………………………………………………………… attested by the
Principal/ Dean/ Head
2. Name of Candidate : ………………………………………………………………
of School/College/
3. Date of Birth : ……………………………………………………………… Institute

4. Father’s Name : ………………………………………………………………


5. Stream: 6. Zone: 7. Category:
8. Percentage of Marks* (* In case of CGPA System of marks please convert the same to percentage system)
a. 10th .......................………………..
b. 12th .......................………………..
c. Graduation ............……………….
9. Name of Present Institute .........................................................................………………………………………………
10. Name of the Certificate/ Degree Course presently undergoing ........……………………………………………………
11. Total duration of the Course ....................................................................……………………………………………….
12. Type of Academic System being followed by the Institute (Annual / Semester type) ............…….
13. Name of the body approving the present Institute & the course in which the above mentioned Student is studying
(ex : CBSE / ICSE / MCI / AICTE etc.) ...........................………………………………………………………………….
14. Date of approval by the body as mentioned at Sl. No. 13 above ............................……………………………………
15. Bank Details
(i) Name and Address of the Bank & its branch where account is held by the candidate (preferably State Bank
of India) ...................................................................………………………………………………………………..
...................................................................…………………………………………………………………………..
(ii) Branch Code Number : ………………………………………..
(Sate Bank of India Nearest to
your Branch)
(iii) Bank A/ C No. / SB A/c No. : ………………………………………..
16. Email ID (valid for at least 4 years): …………………………………………………

Date : ___ / ___ / ______ Signature of the student

This is to certify that the student has taken admission on ...................(date) ........... (month)…..............(Year).
(1st / 2nd/ 3rd/ 4th year) of .............................. (Name of course 11th/ 1st year of 2 years ITI Course / Engineering degree
/MBBS /MBA) and the information given above is correct as per records of our institute. Certified that he / she is not in
receipt of any other scholarship from any other source. The institute shall inform IOCL in case the student accepts any
other scholarship from any other source.

Postal Address of School / College/ University/ Institute: Signature & name of Head/Dean / Principal of
School / College/ University/ Institute with date
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…………………………………………………………………
State:………………………………….Pin………………….. Seal of School / College/ University/ Institute

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