SELF ASSESSMENT FORM Name of the University: Degree Title / Program:. Applicant s Name: Gender: Male Female. Applicant - - CNIC No.. Marital Status Single Married Divorced. Age : Domicile 5. Present Address 6. Perma ne nt Addres s: 7. Are you currently working : Yes No 8. 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: Income available after deduction of taxes etc.. Tel (Res.): Mobile: Email:. Total Family Members currently living with you: S # Name of Family Member (s) Relationship Marital Status Remarks** 5 6. Details of Family Members Earning (Take extra sheet if required): Fa mily M e m b e r Monthly S Family O r ga ni zatio n Relationship occupation Designation G ross Remarks # M e m b e r N a m e Name (Sp e cif y) Pa y/ Ea rni ng Total Monthly Family Income (add self income, if applicable) Pak Rupees
5. Brothers/Sisters/Children/Family Members studying Re lation S # Name with Name & Address of Institute Fee per month applica nt 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 Bus iness 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 # Income Source Father Mother Spouse Self Other Total Property Rent Land Lease Bank Deposits* Shares / Securities* 5 Other (Specify) 8A Total
9. Total Family Monthly Income M o nthly In co m e M o nthly G ros s Monthly Net S # Family Member Name Relationship from Assets Pa y/ Ea rni ng (Take home) Pay/Earning 5 Applicant Monthly Gross Pay/Earning 6 Applicant Monthly Net (Take home) Pay 9-A T otal Monthly Inc ome in Pa k 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 S # Rent Payment: Self Employer/Govt Others House Plot Size in Sq. ft. Covered Area in Sq. ft. Number Of Accommodation Number Of Acc ommodation Acc ommodation Air Location /Address Bed Rooms Monthly Re nt Annua l Re nt conditioners - - - - -6-6 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)
. Utilities Expenditures Last Month Utilities Paid Telephone Electricity Gas Water. Medical Expenditures: Average of last six months (Per Month Expenditure) Total Family Expenditures E du c ation A c c o m mo d ation Utilities M e dic al Misc. T otal M o nthly Tot al An nu al S # E xp en ditur e E xp en ditur e E xp en ditur e Expenditure Expenditure Expenditure Expenditure S # Description Amounts in Pak Rupees (Sec.9A) (Sec. ) (9.A A) Total Monthly Income Total Monthly Expenditure Net Monthly Disposable Income* S # Description Amounts in Pak Rupees (Sec.9B) (Sec. ) 5 ( 9.B.B ) Total Annual Income Total Annual Expenditure 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 S # Tr ans port Ty pe (Car/ Motor cycle/ Others*) Make /Model Engine Capacity (CC) Registration No. O w n ers hip Pe riod * Others: include tractor, rickshaw, bi-cycle, motorcycle rickshaw, carriage pick, truck etc.
Chief Minster s Education Endowment Fund Scholarship Programme (CMEEF) 7. Number of Cattle(s) (with kind) 8. Area and location of Land(s)/Plot(s) owned Cultivable Agricultural Assets Title Qty Size Location (Address) Area Yield per Acre Residential Commercial Agricultural Employer/Govt Scheme 9. Assets worth (Current Market Value in Pak. Rs.) S # 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 Education * 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: Level of Study Name and Location of Per Month To- From Division/ %age / Institute Fee month/ yr. GPA/ CGPA Bac helors Inte rme diate Secondary 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) Total Total Class / Level at which Scholarship S # Name of Institute Scholarship Scholarship Scholarship was Name Amount Period 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.. HED reserves the right to use information given in this form for verification and other purposes.. HED reserves the right of legal action if the information given/provided is found incorrect/false.. Change of subject within the approved disciplines will be allowed subject to approval of Scholarship Management Committee for Chief Minister Education Endowment Fund but not to any other subject. Date: Parents / Guardian Signature A p plic ant Sig nat ur e: _