FORM
(F–1)
F–1
CENTRAL BOARD OF SECONDARY EDUCATION
MERIT SCHOLARSHIP SCHEME
Registration No.
(To be filled by
CBSE)
[ For SINGLE GIRL CHILDREN who have passed Class X from CBSE
May 2011 & pursuing XI & XII from CBSE affiliated School ]
(PLEASE SEE ATTACHED INSTRUCTIONS)
1.
4.
7.
8.
Name of applicant (as per Class X certificate)
2. Date of Birth
(DD/ MM/ YYYY)
____/_____/________
5. Address for correspondence
Mother’s Name
3. Roll No. (Class X)
6. Year of Passing class X 2011
CGPA Obtained _______
Father’s Name
(As per statement of subject-wise
performance issued by the Board.)
No. of Brothers ___ (excluding you) State
No. of Sisters ____ (excluding you) Pin code
Nationality _____________
9. Category (TICK √ )
GEN/ OBC/ SC/ ST/ PH
11. Phone Number (with STD code) _____/____________
Mobile No. ________________________
10. Email Address
12. Particulars of Savings Bank Account
a)
b)
Account Number
(Applicant only)
Name of the Bank &
Address (City and State)
14. School Code
Name and Address of the ______________________________________________________
of Class XI
13.
__________________District ________________ State ___________
School of Class XI
_________
Tuition fee charged by Class X____________ Per Month
Class XI____________ Per Month
the school mentioned (Even if you have not studied in the present school)
15. above
(Affiliated with CBSE / any other Board) (TICK √ mandatory field)
16.
Enclosure attached
17. Signature of Applicant
1.
2.
Photocopy of mark sheet
Original Affidavit duly sworn in before the First Class
Judicial Magistrate/ SDM/ Executive Magistrate, as per
prescribed format from the Parents
(Photocopy of Affidavit will not be accepted)
_______________________ Date
Yes/ No
Yes/ No
________________________
TO BE FILLED IN BY THE PRINCIPAL OF THE SCHOOL FROM WHERE
THE STUDENT IS PURSUING HER CLASS XI
18.
Recent Color
Photograph of the
Applicant duly attested
by the Principal of
School
The facts stated above are hereby certified to be true and correct. The
School is affiliated with the CBSE, Class _____________upto year 20
to
20
vide AFFILIATION NO. ________________
Signature of Principal
Name
Telephone & Mobile No.
Seal
NOTE: Incomplete application will be treated as cancelled.
INSTRUCTIONS FOR FILLING FORM (F – 1)
Eligibility Criteria
The applicant should fulfill all the criteria given below for consideration and
award of scholarship:(i)
should be an Indian national.
and
(ii)
should be the girl child and only child of her parents.
and
(iii) should be a student of CBSE in Class X (i.e. passed class X from a CBSE
affiliated school) and having 6.2 or more CGPA in Class X
Examinations 2011 conducted by the Board and pursuing Class XI & XII
from CBSE affiliated Schools
(As per statement of subject-wise performance issued by the Board).
and
(iv)
the tuition fees for Class X should not be more than Rs. 1,500/- per month
during the Academic year. In the next 02 years the total enhancement of
tuition fee shall not be more than 10% of the tuition fee.
Value of scholarship
Rs. 500/- per month
Duration
02 years only (for Class XI & XII)
Signature
All the application must be signed by the applicant. Unsigned applications or signed by
the parents will be rejected.
Attestation
All the applications must be certified along with signature/ stamp of the Principal of the
present school where the student is studying. In case applications are not attested the
same will be rejected.
Documents to be sent with the APPLICATION


An attested copy of Mark sheet of Class X 2011 issued by CBSE.
An affidavit from the parent that the candidate is the only child of her parents on
a non-judicial stamp paper of Rs. 10/- duly sworn in before First class Judicial
Magistrate/ SDM/Executive Magistrate should be submitted along with the
application. Photocopy of affidavit will not be accepted.
Where to send Duly filled up Application Form
The duly filled in proforma be sent in an envelope superscribing “APPLICATION FOR
MERIT SCHOLARSHIP FOR SGC X 2011 (F-1)” should be sent to the “SECTION
OFFICER (SCHOLARSHIP) CBSE, SHIKSHA KENDRA, 2, COMMUNITY CENTRE,
PREET VIHAR, DELHI–110 092”. Change of address must be intimated
immediately.
NOTE:

Scholarship will be sent to the correspondence address of applicant mentioned in
application form. List of eligible applicant who is being sent scholarship will be
displayed / updated on website regularly.
Jurisdiction of Courts/ Tribunals
a)
b)
c)
A Scholarship once cancelled shall not be renewed under any circumstances.
The decision of the Board shall be final and binding in all such matters.
Any resultant dispute arising out of this scholarship scheme shall be subject to
the sole jurisdiction of the court situated in Delhi/ New Delhi only.
FORMAT OF AFFIDAVIT TO BE ATTACHED WITH THE
APPLICATION
(ON NON-JUDICIAL STAMP PAPER OF RS.10/- SWORN BEFORE
FIRST CLASS JUDICIAL MAGISTRATE/SDM/EXECUTIVE MAGISTRATE
FROM THE PARENTS)
I ___________________ s/o / d/o _____________ r/o __________________ do
hereby solemnly affirm and declare as under:-
1)
That ____________is my only one daughter and her date of birth is _________.
2)
That I am the father/mother and Ms. ________________ is my only daughter.
3)
That I have no other child except my above named daughter.
DEPONENT
VERIFICATION
VERIFIED AT ON THIS ______________ DAY OF ____________ AND THE
CONTENT OF THIS AFFIDAVIT ARE TRUE AND CORRECT AND NOTHING
MATERIAL HAS BEEN CONCEALED.
DEPONENT
(Strike off whichever is not applicable)