THE AGA KHAN UNIVERSITY FACULTY OF HEALTH SCIENCES APPLICATION FOR FINANCIAL ASSISTANCE

Transcription

1 THE AGA KHAN UNIVERSITY FACULTY OF HEALTH SCIENCES APPLICATION FOR FINANCIAL ASSISTANCE Programme Academic Session Name of Student Recent Colored Photograph Application No. IMPORTANT NOTE: Last date for submission of completed application is mentioned in the admission offer package. Incomplete and / or late applications for financial assistance will not be considered. No exceptions. Submission of an application for financial assistance does not guarantee award of Financial Assistance. The University expects honesty from students and their parents. Incorrect information or concealment of information will result in denial of financial assistance. The University also reserves the right to take strict disciplinary action against such applicants including possible expulsion from the university. The financial assistance programme aims to assist students who do not have resources to generate funds to meet their educational expenses. Serious efforts must be made to raise funds (loans and scholarships) from all other sources before applying to Aga Khan University for assistance. Applications that do not bear evidence of efforts for raising funds from other sources may be rejected. University reserves right to verify the information and evidence from the documented source or third party and conduct inquiry. DOCUMENTATION REQUIRED: The application MUST be supported by legible photocopies of evidence regarding details stated in this form. At the minimum, following documents for all earning members of the family, including self as applicable should be provided. Latest salary slips (of last three months)/certificates/affidavit in case of business (all earning members) Copy of latest Income Tax return and Wealth Tax statements of all earning member (Where applicable) Bank statement of all accounts for all members in the family. (for last 1 year for Jan to Dec) Income and Expenditure details for last 1 year (in case of business) Evidence of educational expenses paid for other family members (for last six months) Copy of Electricity, Gas and Telephone Bills (for last three months) Documentary evidence with complete details of all assets / properties owned (house, plot, business, agricultural land/ car(s) etc.) Lease/Rental agreement of all Properties taken/given on lease/rent Documentary evidence of all Investments held (Saving certificates, fixed deposits, insurance policies, etc.) Documentary evidence of loans taken and its repayment schedule. Documents relevant to property and investments are required once during enrollment at AKU (with the first application). With subsequent applications, documentary evidence is required for new transactions only.

2 1. Name of Student 2. Date of Birth Day Month Year 3. Father s / Guardian s Name 4. Father s Guardian s Occupation Service Name of Company / Employer Designation Business Nature of Business Retired Date of Retirement Position in case of Service Organization / Business Last drawn Salary Commutation received at time of Retirement (in case of salaried person) 5. Business / Service address of Father / Guardian Tel: 6. Corresponding Address Tel: 7. Permanent Residential Address Tel: 8. Address (self) Mobile No. 9. Type of Accommodation (Please tick / write in column applicable ) Type of Accommodation Flat Townhouse Bungalow Other Rented* Owned** Provided by Employer ** No. of Rooms (self) Area of Plot (Sq. yards) (Guardian) Covered Area (Sq. yards) *(Please provide rent agreement) **(Please provide documentary proof) Page 2 of 8

3 10. members residing with the family : 11. Particulars of all immediate family members (whether or not residing with the family) Name Age Relationship with Student Marital Status Occupation Designation / Nature of Business Institution / Organization (use extra Sheet if required) 12. Name of the Educational Institution last attended: 13. educational charges paid in the last two years Rs. US$ How were they financed? Through Family Resources Scholarships Other source Scholarship/Other sources (Please specify) (Please provide documentary evidences of scholarship, if any) 14. Detail of employment prior to admission: (if applicable) Name of Organization Designation Salary per month during the programme Experience (in years) other benefits (Please attach a copy of salary slip of last drawn salary) Status of job during this programme: Working On leave with pay On leave without pay Resigned Did you ask the organization to sponsor your educational expenses for this programme? Yes If yes, outcome amount Rs. If resigned, Date of resignation Commutation Received Rs. 15. Other organizations/institutions approached for financial assistance. (Banks, father's/mother s/guardian's employer etc. - please provide evidence) Name of Organization Amount Applied for Outcome No Page 3 of 8

4 16. Are any of the family members other than father/mother/guardian supporting your educational expenses at AKU? Yes No If yes, please specify: amount Rs. /US$ Relationship 17. What alternate arrangements have you made or are able to make in case Financial Assistance is not approved for you? 18. Have you or any member of the family been overseas in the last 2 years? Yes No If yes: Who travelled? Purpose of travel When? Duration of stay Places visited Amount spent Rs. US$ How was the cost financed? Family resources: Sponsored by employer: Others: (If support is from more than one source, specify % from each source 19. Are you staying in University s Hostel? Yes No 20. Details of Bank and Cash Balances Bank Balances Title of Account Name of Bank Currency Balance as at December 31 Sub Bank Balance Cash in Hand Cash and Bank Balance Please note that bank statement should be from Jan to Dec of the previous year) Use extra sheet if required 21. Please give details of the following household items that exist in your house: Make and Model Yes / No i). Car ii). Motorcycle iii). Air Conditioner iv). Television v). Computer / Laptop How many Current Market Value (PKR / USD) Page 4 of 8

5 22. Please give details and provide evidences of the following: Residential House Size of Plot Covered Area No. of Rooms CMV * Other House Property a. Size of Plot Covered Area No. of Rooms CMV * b. Size of Plot Covered Area No. of Rooms CMV * c. Size of Plot Covered Area No. of Rooms CMV * Business Property a. Size of Plot Covered Area Location CMV * b. Size of Plot Covered Area Location CMV * c. Size of Plot Covered Area Location CMV * Plots a. Size of Plot Location Commercial / Residential CMV * b. Size of Plot Location Commercial / Residential CMV * c. Size of Plot Location Commercial / Residential CMV * Agricultural Land Area (in Acres) Location CMV * Production (name and frequency of crops) Other Assets / Investments a. Savings / Investments Rs. / USD b. Saving Certificates Rs. / USD c. Stocks / Shares Rs. / USD d. Prize Bonds Rs. / USD e. Other assets / investments Rs. / USD * Current Market Value 23. Loan Taken Please provide details of loan taken from financial institutions excluding loan granted by AKU for current program Name of Bank / Institution Purpose Date of loan availed Principal Amount Rate of Interest Annual Repayment Outstanding as on December 31 PKR / USD PKR / USD PKR / USD Page 5 of 8

6 24. Details of Annual Family Income (Please indicate income of all family members): (Foreign students are requested to state income and expenses in US$) a. Income from Salary Basic Salary Allowances Annual Bonus Leave encashment Assistance for travel Others (Please specify) Gross Salary Less Deductions Income Tax Provident Fund Loan(s) Others (Please specify) Deductions Net Salary Father Mother Other Member Other Member Rs. / USD Rs. / USD Rs. / USD Rs. / USD b. Pension c. Income from Business/Profession Annual Income/Receipts Less Annual Expenses/Payments Business Income d. Agricultural Income e. Other Income Rs. / USD i). From house property ii). From business property iii). From investment iv). From saving % v). Any other source (please specify) Other Income Annual Income (a + b + c + d + e) (In case of nonexistence of documentary evidences, please provide affidavit mentioning completed details) Page 6 of 8

7 25. Details of Annual Family Expenditures (Please provide appropriate evidences for expenses incurred) a. House Hold Expenses Rs. / USD House Rent Maintenance of House Utilities: Electricity Telephone / Mobile Gas Government Taxes Transportation Annual Food / Grocery Servant Clothing Medical Expenses Travel Entertainment Within Pakistan Overseas (Property, Sewerage, Water etc.) (Bus, Rickshaw, Vehicle Fuel etc.) (Cook, Gardener / Maid / Driver) No. Hotel Expenses Club Membership Other Expenses (please provide details in attachment) House Hold Expenses b. Educational Expenses (excluding Applicant s expenses at AKU) School / College Rs. / USD For Siblings / Children in Pakistan Tuition and other Fees Boarding & Lodging Private Tuition Books, Stationery, Uniform and other expenses For Siblings / Children not in Pakistan Tuition and other Fees Boarding & Lodging Books, Stationery, Uniform and other expenses Educational Expenses University Rs. / USD Rs. / USD c. Other Expenses Rs. / USD Legal Expenditures Loan Repayment: Other financial Institutions (Please provide evidence) Donations Payment of Insurance Premium: Family/Car Other Expenses Grand (a+b+c) Page 7 of 8

8 26. Surplus / (Deficit) Rs. / USD Income Less: Expenditure Surplus / (Deficit) 27. In case of Deficit, please specify how the deficit was managed last year? 28. Financial arrangements AKU: Tuition and other Fee Hostel Fee (if applicable) Family resources Other Sources, (scholarship, sponsorship etc.) Financial assistance requested from AKU covering Rs. / USD UNDERTAKING 1. I understand that submission of this application does not guarantee award of financial assistance, nor does it absolve me of any financial responsibility in relation to study at AKU. 2. The information given in this application is complete and true to the best of my knowledge. I understand that concealing information or providing incorrect information will result in denial of financial assistance and may also result in strict disciplinary action, including possible expulsion from the university. 3. I agree to abide by the decision of the Financial Assistance Committee. Signature of Applicant : Date: Signature of Parents/Guardian : Date: Page 8 of 8