AnnexureI

UNIVERSITY GRANTS COMMISSION

BAHADURSHAH ZAFAR MARG
NEW DELHI 110002
Passport
SA-III SECTION
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Joining Performa for fresh awardees
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SPECIAL SCHOLARSHIP SCHEME FOR NORTH EASTERN REGION

Name of student:_______________________________________________________

Award letter number and date: (to be filled after the selection)_______________________________

Candidate ID number____________________________________________________

This is to certify that Mr./Ms. ________________S/o/D/o ________________________

is a bonafied student of ________year regular, non-professional undergraduate degree

course____________________ in the subject of ________________. He / She joined
the Ist year Undergraduate degree course on dated____________________ in this
Institution/College/Department_____________________________________________
affiliated to _________________________________________University.

Signature Signature Signature

Name Name Name
Date Date Date
(Awardee) (Head of Deptt.) (Registrar / Director / Principal)
Ph. /Mobile No. Seal of HoD Seal of University / Institution / College
e-mail : Ph. No. Ph. No.
Bank A/c No.
IFSC Code :
MICRcode:
12-digit unique (aadhaar) number, if you have: