Name of the University: Degree Title / Program: 1. Applicant s Name: Gender: Male Female 2. Applicant NADRA NIC No.

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1 HEC Needs Based Scholarship Program 06-7 Page of 6 Name of the University: Degree Title / Program:. Applicant s Name: Gender: Male Female. Applicant NADRA NIC No Marital Status Single Married Divorced. Age : Domicile 5. Present Address 6. Permanent Address: 7. Are you currently working: Yes No 8. If answer is Yes to Question No. 7 complete the sections (9-) Designation: Name of Employer /Company: 9. Total Monthly Applicant Gross Income in Pak Rs. 0. Total Monthly Applicant Take Home Income* in Pak Rs. * Take Home Income: Salary / Pay available after deduction of taxes, provident fund charges etc.. Tel (Res.): Mobile: . Total Family Members currently living with you: Name of Family Member (s) Relationship Marital Status Remarks** 5 6. Details of Family Members Earning (Take extra sheet if required): S Family # Member Name Relationship Family Member occupation (Specify) Organization Name Monthly Designation Gross Remarks Pay/Earning Total Monthly Family Income (add Self Income, if applicable) Pak Rs.

2 HEC Needs Based Scholarship Program 06-7 Page of 6 5. Brothers/Sisters/Children/Family Members studying Relation Name with Name & Address of Institute Fee per month applicant 5 6 5A Total Fees & Tuition Charges 6. Father s Name: Computerized N.I.C. No 7. Status: Alive Deceased 8. Professional status: Employed Retired Business Owner 9. Name of Company/Employer: 0. Tel (Off): Mobile:. Occupation Type: NTN. Designation & Grade ( BPS/ SPS/PTC etc): Gross Monthly Income:. Total Net Monthly Take Home Income (Salary/ Pension/ Others):.Any Other Supporting Person (Mother/ Guardian/ Brother/ Sister/Family Relative/Guardian): 5. Name: Relationship: 6. Occupation and Designation 7. Monthly Financial Support Available to Applicant in Pak Rs. 8. Asset Income (on monthly basis) S # Property Rent Father Mother Spouse Self Other Total Land Lease Bank Deposits* Shares / Securities* 5 Other (Specify) 8A Total

3 HEC Needs Based Scholarship Program 06-7 Page of 6 9. Total Family Monthly Income Monthly Income Monthly Gross Monthly Net Family Member Name Relationship from Assets Pay/Earning (Take home) Pay/Earning 5 Applicant Monthly Gross Pay/Earning 6 Applicant Monthly Net (Take home) Pay 9-A Total Monthly Income in Pak Rupees 9-B Total Annual Income in Pak Rupees 0.FAMILY EXPENDITURES 0A. Accommodation Expenditures Type: Bungalow Apartment /Flat Town House Village House Status: Rented Self or Family owned Employer / Govt Owned Rent Payment: Self Employer/Govt Others House Plot Size in Sq. ft. Covered Area in Sq. ft. Number Of Accommodation Number Of Accommodation Accommodation Air Location /Address Bed Rooms Monthly Rent Annual Rent conditioners Above 6 Above 6 0B Total Accommodation Rental Expenditure Any other house/flat owned by the Parents/Guardian (if yes please specify with location and size)

4 HEC Needs Based Scholarship Program 06-7 Page of 6. Utilities Expenditures Last Month Utilities Paid Telephone Electricity Gas Water. Medical Expenditures: Average of last six months (Per Month Expenditure) Total Family Expenditures Accommodation Utilities Medical Misc. Total Monthly Total Annual Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure Description Amounts in Pak Rupees (Sec.9A) Total Monthly Income (Sec. ) Total Monthly Expenditure (9.A A) Net Monthly Disposable Income* Description Amounts in Pak Rupees (Sec.9B) Total Annual Income (Sec. ) Total Annual Expenditure 5 (9.B.B) Net Annual Disposable Income* * If the monthly / Annual Disposable Income is negative, kindly explain the reasons for the gap, and the arrangements through which the differential gap is met by the family Assets (with current market value) 6. Does the family own any Transport? Yes No If yes kindly fill the relevant details Make Ownership Transport Type Engine Capacity (CC) Registration No. /Model Period (Car/ Motor cycle/ Others*) * Others: include tractor, rickshaw, bi-cycle, motorcycle rickshaw, carriage pick, truck etc.

5 HEC Needs Based Scholarship Program 06-7 Page 5 of 6 7. Number of Cattle(s) (with kind) 8. Area and location of Land(s)/Plot(s) owned Residential Commercial Agricultural Assets Title Employer/Govt Scheme Cultivable Qty Size Location (Address) Area 9. Assets worth (Current Market Value in Pak. Rs.) Agricultural Yield per Acre Assets Title Father Mother Spouse Self Guardian Total House Business Land & Building Bank Balance 5 Stocks/Prize bond 6 Others/ Cattle(s) 0. Total. Loan taken for Applicant * Family/ Friend Loan (Specify details of loan taken and relationship with the relative / friend). Any source of financing other than loan (Please specify). How were the admission /first semester charges paid?. Applicants educational record: Name and Location of Level of Study Institute Bachelors Per Month Fee To- From month/ yr. Division/ %age / GPA/ CGPA Intermediate Secondary

6 HEC Needs Based Scholarship Program 06-7 Page 6 of 6 5. Per month fee/ tuition charges of the institution last attended 6. Have you ever got any other Scholarships: Yes No (If yes fill the details of scholarships & attach documentary proof of the scholarships) Name of Institute Scholarship Name Total Scholarship Amount Total Scholarship Period Class / Level at which Scholarship was granted Statement of Purpose (Explain your suitability for this scholarship) - attach separate sheet if required UNDERTAKING. The information given in this application are true to the best of my knowledge and I understand that any incorrect information will result in the cancellation of this application. If any information given in this application is found incorrect or false after grant of financial assistance, the institute will stop further assistance and the student will have to refund all payment received and or penalty equal to total scholarship amount.. HEC reserves the right to use information given in this form for verification and other purposes. Date: Parents / Guardian Signature For Official use only Are the applicant documents in order? Yes No Applicant Signature: Application Case Review Dates (i) (ii) Additional Remarks Date Department Name Signature Head of Department / Focal Person

JSMU & HEC Needs Based Scholarship Program

JSMU & HEC Needs Based Scholarship Program 08-9 Page of 6 Name of the University: Degree Title / Program:. Applicant s Name Gender: Male Female. Applicant NADRA NIC No. - -. Marital Status Single Married