Late THOTA LAKSHMAMMA MEMORIAL VIDYA FOUNDATION

C/o SAI ANADHA SEVA TRUST

Vivekananda Nagar (Banjara Colony), Komatipalli Road, Waddepally, Hanmakonda, Warangal.

APPLICATION FORM FOR FINANCIAL AID

1. Full Name in Block letters with surname :

2. Mother’s Name & profession :

3. Father’s Name & Profession. :

4. Permanent Address with Cell No. :

5. Residential address with Mandal Name :

(Local area certificate should be enclosed)

6. Reference with two prominent persons : 1.

with their full address & Cell Nos. duly

certifying the details given by you.              2.

7. Course for which Financial Aid Requesting:

8. Name of the College in which the individual

got admission with full address and annual

fee payable for the course and period of the

course (Certificate from concerned college

should be enclosed):

9. Annual Income of the Parents :

(Certificate from employer/Tahasildar should be enclosed)

10. Details of Movable/Immovable properties :

of parents. (Self declaration to that extent

should be enclosed)

11. Weather the applicant receiving any

scholarships from Govt. or any other :

institution.

(A self declarationstating that the individual is not taking any financial assistance from any where should be enclosed)

12. Brief history of the carrier the individual

wants to take up in future :

13. Colour passport of the applicant :

(1 should enclose along with application & another should affix on the application)

14. Colour photograph along with the parents:

15. Any other information :

UNDERTAKING

I here by declare that all the entries/statements made in this application are true, complete and correct to the best of my knowledge and belief. I further declare that I am not getting any Financial Aid/Scholarships from State/Central Govt. or any other Govt. /Private Institutions. In the event of any information being found false or incorrect or ineligibility being detected before or after, the Foundation can take action against me as per rule in case it is detected that I have misled Late Thota Lakshmamma Memorial Vidya Foundation on any issue then I will be solely responsible for all penal consequences thereof along with the criminal actions.

Place:

Date:

Signature of the Student.