K. C.

MAHINDRA EDUCATION TRUST

(Public Trust Act-Registration No. E 1245 - Bombay)
APPLICATION FORM FOR MAHINDRA ALL INDIA TALENT SCHOLARSHIP FOR 1ST YEAR DIPLOMA.

Application No. *
(Above entry to be left blank by the Applicant)

Affix
Passport size
Photograph with
your signature.

Read this Form carefully. Incomplete Application Form will NOT be considered.

Applicants Name in full: _____________________________________________________________

Age _________ Date of Birth _______________________________

(as recorded in your School Certificate - Encl. attested copy) (*)

Address for Correspondence:

Pin code

Name of the state:

Telephone/Mobile, if any : e-mail id: ________________________

Category: SC / ST / Others _________________________[Please specify]

Fathers Name in full : __________________________________________________________

Permanent address : __________________________________________________________

Pin code

Name of the state:

Where did you hear about MAITS?

Ad in Newspaper ______________________ (Name of publication/newspaper)
College Notice Board Friends Others _________

Has anyone else in your family (brother/sister) received the Mahindra All India Talent Scholarship:
Yes No Give Details: ______________________________________
Family Information:
Number of family members: ____________________________

Parents Name Level of Employment / Income

Education occupation per Year
Father

Mother

No. of Brothers ________

No. of Sisters ________

Any other source of income or scholarship? Please state amount and number of years: ___________

TOTAL FAMILY INCOME PER YEAR: _________________________

Details of Applicants Educational record :

Name of School/ Name of Examination Stream/ Year Percentage

College Board/University Passed Subjects of marks / CGPA
obtained

XTH (SSC)
(mandatory)

XII (HSC)
(If applicable)

Proposed Course of Study Course duration Total College fees you have
to pay per year
(Give full details of your Diploma Course) in years

Do you live in a hostel? Yes/No

If yes, how much does it cost you every month?________________________________
Admission sought at:
Admission secured at:

(Name and full address of the Institute)

[Enclose copy of admission letter duly attested] *

Course commences from [Date]

Duration of the course

CEEP (Common Entrance Exam) Rank (If applicable): _____________

Name and address of two referees (teacher/employer) - under at least one of whom the applicant has studied
or worked.

1.

2.
Bank Details:

Name of the student as per bank account: ___________________________

Name of the bank: _________________________________________
Bank address: _____________________________________________
Account no. (Account no. for NEFT transfer): __________________________________________
IFSC Code (Mandatory): ___________________________________

Enclosures:

1. Testimonial (Recommendation letter) from any one of the two referees (teacher/employer) mentioned
above.
2. A short statement as to your general aptitude and interest, the type of vocation you would like to pursue
and your ambitions and aspirations in life.
3. Attested copy of Certificate of Date of Birth as recorded in your School Certificate.*
4. Attested copy of Mark Sheets and Certificates of examinations passed. *
5. Attested copy of Letter from Institution where admission has been secured. *
* Candidates who have not secured admission will not be called for the final interview. Therefore
candidates should submit a copy of the admission letter as soon as they secure admission.
6. Family Income certificate copy.
7. Self-attested copy of first page of passbook or canceled cheque.
8. Aadhaar Copy.

Please note that only students who have a bank account can apply for this scholarship.

I hereby declare that the entries in this form are true and if I am selected, I agree to abide by the terms and
conditions of the K. C. Mahindra Education Trust, Mumbai.

Date: Yours faithfully,

_______________________
[Name and Signature of
Applicant]

_______________________
Date: [Name and Signature of
Father/Guardian].

To the best of my knowledge, what is stated above is correct.

________________________
Date : [Name and Signature of the
Institution where you studied last/are studying)
 ELECTRONICS FUNDS TRANSFER MANDATE FORM

To
K.C.MAHINDRA EDUCATION TRUST,
Mumbai.

Sub: Receipt of Scholarship payment through NEFT

I am giving below the details of my bank account for receiving the

scholarship
Instalment payment through NEFT.

(1) NAME __________________________________

(2) Bank Name ______________________________

(3) Bank Br. Address : __________________________________________

__________________________________________

(4) Savings Account No. _________________________________________

(5) IFS Code No: ____________________________

(6) Students Contact No. ____________________

(7) E-Mail Id. ____________________

I have enclosed the following document to this effect.

(a) Cancelled Cheque leaf or Bank passbook containing details of Bank

accounts number, IFS Code

___________________
Signature of the Student.

..
Please submit the filled in form to the nearest centre in your area. Candidate can apply /
submit form to ONLY one of the addresses below:
SR.NO Centre Addresses
1 Mr. Benny John
Mahindra & Mahindra Ltd
34/1128 Balakrishna Menon Road
Edapally PO
Cochin 682024
2 Mr. V Suresh
Mahindra & Mahindra Ltd
Mahindra Towers, 17/18
Pattulos Road
Off.Mount Road
Chennai 600002
3 Mahindra & Mahindra Ltd
Mahindra House, Auto Sector
T.S. Reddy Complex
1-7-1, Park Lane, S.D.Road
Secunderabad 500003
4 Mahindra & Mahindra Ltd
Raheja Chambers
1st Floor, Museum Road
Bangalore 560 001
5 Mahindra & Mahindra Ltd
Automotive Division
7 KYD Street
3rd Fooor
Kolkata 700016
SR.NO Centre Addresses
6 Mr. Deepak Kumar Sinha
(Regional Sales Manager)
Mahindra & Mahindra Ltd.
Automotive Sector
B/1, 701 to 707 & 712,
7th floor, Palladium,
Corporate Road,
Nr. Divya Bhaskar Press,
Makarba, Ahmedabad-380 051
7 Mahindra & Mahindra Ltd
Mahindra Tower, Automotive Sector
1st Floor, 24,25,26 Durga Vihar Colony
Durga Pura, Tonk Road
Jaipur 302018
8 Mahindra & Mahindra Ltd,
FES Swaraj Division
Phase IV Industrial Area
SAS Nagar
Punjab 160055
9 Mr. A. Vishwanath
Vice-President - Corporate Infrastructure
Mahindra & Mahindra Ltd
Mahindra Towers, 3rd Floor
2A Bhikaji Cama Place
New Delhi 110 067
10 Mahindra & Mahindra Ltd
2nd Floor, Mahindra Tower, Auto Sector
Near HAL, Faizabad Road
Lucknow 226016
11 K.C.Mahindra Education Trust
Cecil Court, 3rd Floor
Mahakavi Bhushan Marg
Next to Regal Cinema, Colaba
Mumbai 400 001.