Need Base Qarz-e-Hasna Support Program (Application Form

Page 1 of 15

COMSATS Qarz-e-Hasna Support Program Qarz-e-Hasna FORM

Qarz-e-Hasna is based on assessment of need and merit as well as availability of funds. Selection will be decided on the basis of information provided in this form and investigations for the authentication of provided information. Candidate may be required to appear for interview(s). FALSE INFORMATION Providing false information may result in one or all of the following: Cancellation of admission. Rustication from the Institute. Initiation of legal proceedings. Disqualification for award of any future Qarz-e-Hasna. Refund of all the payments received out of the Fund with or without a penalty not exceeding the total Qarz-e-Hasna amount.

INSTRUCTIONS FOR FILLING THE APPLICATION FORM:

Read the application form carefully; Make a photocopy of the application form; Complete the photocopy form and make sure everything is correct and final; Furnish factual, comprehensive and authentic information in the form; For family financial reporting parents/guardian may be consulted for guidance; Whenever in doubt or lost, seek help from the Focal Person; Check your application for spellings, grammatical errors and factual oversight;
Copy all information from photocopied form to the original form; Fill in the form using black ball point pen and write in capital letters;

Answer all questions. Those not applicable should be marked N/A;

Submit duly completed and signed application form to the QARZ-E-HASNA Award Committee office or the designated focal person;

Keep a photocopy of the filled-in original application form for your record; Ensure that you have attached all the required documents by putting a tick mark in checklist;
and

Affidavit Needs to be submitted after final selection of the candidate.

Definitions: Family: Includes Father, mother(s), brother(s), sisters(s), Maternal / Paternal Uncles (s) & Aunts,
Grandparents, etc.

Need Base Qarz-e-Hasna Support Program

(Application Form)

Page 2 of 15

Application Form Check List

SN 1 Description Copies of computerized NIC of Father Mother Guardian 2 NTN of Father Mother Guardian 3 Copy of last Income Tax Return of Father Mother Guardian 4 Salary Certificate of Father Mother Guardian 5 Copies of last six (06) month utility bills of the residence of present/ guardian Electricity Gas Telephone 6 7 8 9 10 Attested copy of rent agreement (if applicable) of residence Copies of last & latest fee receipts of self and siblings * Copies of Medical bills/ expenditure related documents (if awarded) Copies of previous Qarz-e-Hasna (if applicable) Statement of Purpose
Tick the relevant

* Siblings are brother & sisters

I II III IV DO:

Section A: Personal and family information Section B: Cumulative information of Self, Parents & Guardian Assets Section C: Financial arrangements for current year Section D: Educational Record

Submit by hand to the (Qarz-e-Hasna Committee) office or focal person.

Place documents in right order as per above sections (1 to 10) Put all amounts in Pak Rs. Do consult with parent(s)/guardian(s) for financial data accuracy & reliability For the information not present/relevant write in capital letters N/A

DO NOT:

Provide False/vague/ incomplete information. Overwrite/ scratch on the form

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 3 of 15

Name of the Department: Degree Title / Program:

Section A:
Applicant Personal and Family Information 1. App li can ts Name: Gender: Male Female

2. Registration No: 3. Applicants CNIC No. 4. Marital Status Single Married Divorced

5. Present Address 6. Permanent Address: 7. Are you currently employed :Yes 8. Tel (Res.): 9. Email address: 10. Total Members in the Family:

No Mobile:

11. Number of Family Members currently living with the applicant: 12. Detail of Brothers/Sisters: S# 1 2 3 4 5 6 7 13. Number of Earning Members in Family: Name of Family Member (s) Relationship Marital Status Remarks**

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 4 of 15

14. Details of Earning Family Members:

S # Family Member Name Relationship Family Member occupation *** Organization Name Monthly Designation Gross Pay/Earning Remarks

Total Monthly Family Income (add self income, if applicable) Pak Rupees *** Family Member Occupation classification
1. 2. 3. 4. 5. Government Service (Specify the employment grade BPS/SPS/PTC etc.) Private Job Agriculture/Farming Own Business (Self Employed). Details/nature of self business need to filled in at remarks column Others. Details/nature of self business need to filled in at remarks column

15. Number of family members not earning 16. Brothers/Sisters/Children/Family Members studying ______ 17. Details of Siblings Studying S# 1 2 3 4 5 6 Total Fees & Tuition Charges 18. Fathe r s Na me: 19. Status: Alive Deceased Retired Business Owner Name Relation with applicant Name & Address of Institute Fee per month

Tuition per month

(If applicable)

Computerized N.I.C. No

20. Professional status: Employed 21. Name of Organization/Employer:

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 5 of 15

22. Address: 23. Tel (Off): 24. Occupation: 25. Designation & Grade ( BPS/ SPS/PTC etc): 26. Total Gross Monthly Income (Salary/ Pension/ Others): 27. Previous Occupation (if applicable): 28. Total Annual Income: NTN Mobile:

29 Any Other Supporting Person (Mother/ Guardian/ Brother/ Sister/Family Relative/Guardian): a. Name: b. Address: c. Tel (Off/Res) d. Occupation e. Designation Name of Organization/Employer Mobile No. NIC no. Relationship:

f. Total Net Monthly Take Home Income (Salary/ Pension/ Others): g. Total Net Annual Income h. Monthly Financial Support Available to Applicant in Pak Rs.

30. Other Income (on monthly basis) S# Income Source Father 1 2 3 4 5 Property Rent Land Lease Bank Deposits* Shares / Securities* Other (Specify)

Mother

Spouse

Self

Other

Total

Total * For sources with annual income returns, kindly report the monthly income earned

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 6 of 15

31. Total Family Monthly Income

Monthly Income S# Family Member Name Relationship from Assets (Sec. 45) Monthly Gross Pay/Earning Monthly Net (Take home) Pay/Earning

1 2 3 4 5 6
Applicant Monthly Gross Pay/Earning Applicant Monthly Net (Take home) Pay/Earning

Total Monthly Income in Pak Rupees

32. FAMILY EXPENDITURES a. Accommodation Expenditures Type: Bungalow Status: Rented Rent Payment: Self House Plot Size in Sq. ft. b. Utilities Expenditures
Last Month Utilities Paid Telephone Electricity Gas

Apartment /Flat Self or Family owned Employer/Govt

Town House

Village House

Employer / Govt Owned Others

Covered Area in Sq. ft.

Average of Last Six Months (Per Month Utilities Charges)

S#

Telephone

Electricity

Gas

Total

33. Monthly Food /Kitchen Expenditures 34. Medical Expenditures: Average of last six months (Per Month Expenditure) 35. Travelling/ Miscellaneous Expenditures _____________________________________ 36. Average of last six months (Per Month Expenditure)

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 7 of 15

37. Total Family Expenditures

S # Education Expenditure Accommodation Expenditure Utilities Expenditure Food Expenditure Medical Expenditure Misc. Expenditure Total Monthly Expenditure Total Annual Expenditure

S#

Description Total Monthly Income Total Monthly Expenditure

Amounts in Pak Rupees

S#

Description Total Annual Income Total Annual Expenditure

Amounts in Pak Rupees

* If the monthly / Annual Income is negative, kindly explain the reasons for the gap, and the arrangements through which the differential gap is met by the family

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 8 of 15

Section B:
Cumulative information of Self, Parents and Guardian Assets

Assets (with current market value)

38. Does the family own any Transport? If yes kindly fill the relevant details
S# Transport Type (Car/ Motor cycle/ Others*) 1 2 3 4 Make /Model Engine Capacity (CC) Registration No. Market Value Ownership Period

Yes

No

* Others: include tractor, rickshaw, bi-cycle, motorcycle rickshaw, carriage pick, truck etc. 39. Number of Cattle(s) (with detail) 40. Area and location of Land(s)/Plot(s) owned Assets Title Residential Commercial Agricultural Employer/ Scheme Govt Qty Size Location (Address) Cultivable Agricultural Market Area Yield per Value Acre

41. Assets worth (Current Market Value in Pak. Rs.) S# 1 2 3 4 5 6 7 House Business Land & Building Bank Balance Stocks/Prize bond Others/ Cattle(s) Transport Total 42. Taxes paid (per annum in Pak. Rs) Assets Title Father Mother Spouse Self Guardian Total

Need Base Qarz-e-Hasna Support Program (Application Form)

Page 9 of 15

Section C:
Financial arrangements for current year

43. Funds Availability for Applicant Education (per month in Pak Rupees) S# 1 2 Income Source Salary / Earnings Family / Friend Advances & Loan * 3 4 Bank Loan Other (Specify) Father Mother Spouse Self Other Total

Total * Family/ Friend Loan (Specify relationship with the relative / friend)

44. Any source of financing other than Qarz-e-Hasna (Please specify)

45. How were the admission /first semester charges paid?

Need Base Qarz-e-Hasna Support Program (Application Form) 10 of 15

Page

Section D: Applicants Educational Record Name and Location of Institute Fees Division/ GPA/ %age / CGPA

Level of Study Bachelors Intermediate Secondary

To- From month/ yr.

46. Per month fee/ tuition charges of the institution last attended _ 47. Has the applicant ever been awarded any other scholarship before: Yes (If yes fill the details of scholarships & attach documentary proof of the scholarships) S# 1 2 3 48.Statement of Purpose (Explain your suitability for this previous Qarz-e-Hasna) - attach separate sheet if required Name of Institute Scholarship Name Total Scholarship Amount Total Scholarship Period Class / Level at which Scholarship was granted No

UNDERTAKING 1. The information given in this application is true to the best of my knowledge & belief and nothing has been concealed therefrom and I understand that any incorrect information will result in any or all of the following:

Cancellation of admission. Rustication from the Institute. Initiation of legal proceedings. Disqualification for award of any future Qarz-e-Hasna. Refund of all the payments received out of the Fund with or without a penalty not exceeding the total Qarz-e-Hasna amount. CIIT has the right to use information given in this form for verification and other purposes.
Parents Signature Guardians Signature Applicants Signature:

2.

Date:

Need Base Qarz-e-Hasna Support Program

For Office use only Are the applicants documents in order? Yes No

The notices furnished/delivered to the applicant for furnishing of required documentation S# 1 2 3 4 Application Case Review Dates (i) Additional Remarks (ii) Notice Date Document Name Missing Document Submission Date Remarks

Date

Focal Person

Department Name

Signature Head of Department

Need Base Qarz-e-Hasna Support Program