JAYA SATYA PRAMODA NIDHI (Regd Trust) (A Division Of Satya Pramoda Foundation)

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JAYA SATYA PRAMODA NIDHI (Regd. Trust) (A Division Of Satya Pramoda Foundation) Regd. Office: Uttaradi Math, Pooja Mandira, Uttaradi Math Road Basavanagudi, Bangalore-560004 (Established by Sri Sri 1008 Sri Satyapramoda Teertharu) ________________________________________________________________________ c) Earning Member Details: Name of Earning Member Total Annual Gross Income 7) Total Annual Gross Income of All Earning Members: ............................ 8) Parents/Guardian residence address: ........................................................................................................ House No.: ............................... Street/lane: ............................................. At:......................................... Post: .................................... Taluk: ...................................... Dist: ............................... Pin Code: .................................. Tel. No. (With STD code) : ........................................... Mobile No: …………………………………………… 9) College address :........................................................................................................................................ House No.: ............................... Street/lane: ............................................. At:......................................... Post: .................................... Taluk: ............................... Dist: :......................................... Pin Code: .................................. Tel. No. (With STD code) : ........................................... Mobile No: …………………………………………… 10) Student's contact address: ......................................................... Street/lane: .............................. (If staying in hostel or room) At:.......................................... Post : .................................. Taluk: .......................... Dist: ....................... Pin Code: ....................... Tel. No. (With STD Code) ............................... Mobile No: ……………………………. For immediate correspondence please give your E-mail ID: ............................................. DONATE TO EDUCATE THE NEXT GENERATION
JAYA SATYA PRAMODA NIDHI (Regd. Trust) (A Division Of Satya Pramoda Foundation) Regd. Office: Uttaradi Math, Pooja Mandira, Uttaradi Math Road Basavanagudi, Bangalore-560004 (Established by Sri Sri 1008 Sri Satyapramoda Teertharu) ________________________________________________________________________ 11) Currently Studying: …………………………………………………………….. 12) Marks and Percentage Obtained in SSLC/PUC 1 st Year Examination: ……………….. 13) Class Admitted: Class: .......................... Roll No.: .................... Division: .............................. 14) If poor academic performance, give reasons. (If necessary use extra paper) ............................................................................................................................................. ........... 15) Fees paid to the college for this academic year: .............................. (Attach attested copies of receipts) Amount yet to be paid: ........................... (Attach original estimated expenditure statement) 16) Have you received financial assistance from any other sources? (If yes give details) ............................................................................................................................................. ............ ............................................................................................................................................. ............ 17) Give the details of extra curricular activities (If participated in Taluk, Dist. or higher level. Enclose the attested copies of certificates)..................... ..................................................................................................... ............................................................................................................................................. ............ 18) Attach following documents with the application. Tick mark (√) i) Attested copy of fee receipts. How many receipts? Rs. ii) Attested copy of SSLC marks card/Puc 1 st year (Send provisional marks card, if original marks card is awaited) Date: Signature of Student ____________________________________________________________ Carefully read the details given overleaf before filling the application form. Duly filled in application forms should be sent on or before 31.07.2010 to “Jayasatyapramoda Nidhi”, C/o Uttaradi Math, 5 th Cross Road, Shankarpuram, Basavanagudi, Bangalore – 560 004 DONATE TO EDUCATE THE NEXT GENERATION
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JAYA SATYA PRAMODA NIDHI (Regd Trust) (A Division Of Satya Pramoda Foundation)

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