APPLICATION FORM FOR THE GRANT OF MERIT SCHOLARSHIP OUT OF BENEVOLENT FUND FOR PAI Ws Name of Government Servant Designation _ 3. Pay Scale Present Department. Parent Department (if other than S.No), Place / Station of Duty 7 Computerized NICNo. (ane a] al [ : 8 Contact No (Phone): 9. Mobile: (with area code) 10, Name of Student. 11.Class 12, Year of Examination. 13. Date of declaration of Result 14, Total Marks 15. Marks Obtained 16. Percentage __ 17. Name of Institution (Exam: passed from) with complete address Ido hereby solemnly affirm / verify that the contents of the above application are true to the best of my knowledge and belief and that I have concealed nothing, Signature of the Student Signature of Government Servant with date Complete Residential Address: CERTIFICATE FROM THE HEAD OF THE INSTITUTION CONCERNED Certified that as per record of this institution entries recorded against S.No.10 to 17 above are correct, he / she obtained marks in Board / University Final Examination (ear), Dated ynature & Seal of Head of Institution ‘THIS CERTIFICATE SHOULD BE ISSUED BY THE “HEAD OF DEPARTMENT” CONCERNED Certified that the applicant is a Provincial Government servant; contributing to Provincial Benevolent Fund Board and that the details furnished at S.No.1 to 9 above are correct as per our official record Dated "Signature & Designation of Head of Department with Official Seal ummm © For Attachments & instructions see overleafATTACHMENTS: Attested / verified copies of the following documents must be attached: - Payroll. Detailed Marks Certificate (DMC). Copy of Computerized NIC. Certificate that the applicant holds status of Civil Servant / Provincial Government Employee. Benevolent Regular Contribution Certificate. INSTRUCTIONS. Form should be filled in capital letters. Deficient and Incomplete application forms not submitted through Heads. of Administrative Departments concerned shall not be entertained. Applications invited / submitted for a specific academic year shall be entertained only for that academic year. Provincial Government servants, who are contributing towards Khyber Pakhtunkhwa Benevolent Fund. Applications received after due date shall not be entertained.