Zahid Bashir Patient Aid Foundation Scholarship Form

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ZAHID BASHIR

PATIENT AID
FOUNDATION
SCHOLARSHIP
`
FINANCIAL ASSISTANCE

This financial assistance is based on assessment of legitimate need. The committee takes
decisions on the basis of information provided in this form and its own investigations. Candidates
are also required to appear for interview to provide additional information.

IN CASE OF PROVIDING FALSE INFORMATION:

➢ In case of fresh applicant, cancellation of financial assistance application and / or


cancellation of admission in case of 1st semester student. Such applicant / student will
also be disqualified for applying for any further loan / financial assistance.

➢ In case of existing student, in addition to the above consequences, further assistance will
be stopped and the student will have to refund all financial assistance payments received
till that date and / or penalty equal to total financial assistance amount on immediate
grounds. Such applicant / student will also be disqualified for applying for any further loan
/ financial assistance.

➢ The concerned students will be liable for prosecution on legal grounds.

DISCLAMIER:

ZAHID BASHIR SCHOLARSHIP reserves the right to verify physically or otherwise all
information submitted by the candidates for purposes of loan/financial assistance.

Date Signature of Parent / Guardian Signature of Applicant

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GUIDELINES FOR FILLING OUT THE FINANCIAL ASSISTANCE APPLICATION FORM

1. Read the general information thoroughly, which will enable you to complete the application form.

2. Attach the following as supporting documents along with your financial assistance application
form.

a. NADRA Family Registration


b. Copies of CNIC Self, Parents/Guardian and Siblings (NADRA Family Registration Certificate)
______
c. Death Certificate, in case any of the parent has passed away. ______
d. Salary slip or salary certificate (or pension slip) of all earning family member(s). ______
e. Bank statement for last six months of all family members having all accounts. ______
f. Income tax returns of all earning family members for last year. ______
g. Fee bills and any concession document from the last institution you have attended. ______
h. Utility bills last six months;
i) Electricity ii) Telephone iii) Gas iv) Water ______
i. Saving certificates, bonds, shares, investments, CDC account statement. ______
j. Property ownership documents, including agriculture land, plots and houses. ______
k. Rent agreement (if applicable) ______
l. Loan document(s), including credit card bills and bank loan statements. ______
m. Medical bills / expenditure related documents. ______
n. Latest fee challans/Fee concession (scholarship/loan) document(s) of sibling(s). ______
o. Wealth statement for all family members for last year (If applicable). ______
p. Domicile certificate. ______
q. Copy of Academic Certificates including Mark-Sheets i.e. Matriculation,
Intermediate, Graduation and previous year/term/semester. ______
r. Any other relevant document(s) necessary to support your application. ______
s. Statement of purpose. ______

3. Submit the above said documents to the relevant OFFICE for onward submission to the Financial
Assistance Committee.

TIPS FOR COMPLETING APPLICATION FORM


4. Furnish factual, comprehensive and authentic information in the form.
5. Provide educational information in chronological order.
6. Carefully note down your enrollment number and remember to use it correctly during future
correspondence.
7. Answer all questions. Those not applicable should be marked N/A. All required documents are to
be attached.

PLEASE AVOID THE FOLLOWING

Х Providing vague / incomplete information.


Х Overwriting / scratching information on the form.
Х Mailing your application.
Х Submitting the documents in wrong order without card file.

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Х Leaving any questions unanswered.

NON – FINANCIAL DETAILS OF THE FAMILY


Section A: Applicant’s information
1. Applicant’s Name ______________________________________ Affix two
2. Father’s/Guardian’s Name_______________________________ Passport Size
3. Enrolment (ERP#)/Seat Number __________________________ Photographs
4. Program/Class ___________________________GPA/CGPA____
5. CNIC Number _________________________________________
6. Domicile _____________________________________________
7. Residential Address: ___________________________________________________________
8. Tel. # (Res)________________ Mobile #____________________ Fax # __________________
9. Email ID ________________________________________________
10. Marital Status: Single ___________ Married _____________
11. Name of Last Educational Institution attended:
a. SSC/O Level ____________________________________
b. HSC/A Level ____________________________________
c. University _____________________________________

12. Have you or any other member(s) of your family ever been awarded (Past & Present)
scholarship? Yes _______ No_______ (If yes), provide details below:

Name Scholarship Program Award Year Course and Institution

13. Present Occupation (if any, please give full details)

Nature of employment_________________ Name of Company / Employer__________________

Monthly Income Gross _________________ Net ________________________

Annual Income Gross __________________ Net ________________________

Previous Occupation (if applicable) ___________________________________

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Section B: Parents’/Guardian’s Information

1 Father’s / Guardian’s Name


2 CNIC Number_________________________________________National Tax Number. __________________
3 Residential Address (if different from above): __________________________________________________
4 Tel.(Off) __________________Mobile #_________________ Fax # ____________Email. _________________
5 Present Occupation (Give full details)__________________________________________________________
6 Designation __________________________________ Name of Company /Employer ___________________
7 Monthly Income Gross ________________ Net ___________________ Pension (if retired)______________
8 Annual Income Gross ________________ Net ___________________
9 Previous Occupation (if applicable) ___________________________________________________________

10 Mother's Name
11 CNIC Number_________________________________________National Tax Number. __________________
12 Residential Address (if different from above): __________________________________________________
13 Tel.(Off) __________________Mobile #_________________ Fax # ____________Email. _________________
14 Present Occupation (Give full details)__________________________________________________________
15 Designation __________________________________ Name of Company /Employer ___________________
16 Monthly Income Gross ________________ Net ___________________ Pension (if retired)______________
17 Annual Income Gross ________________ Net ___________________
18 Previous Occupation (if applicable) ___________________________________________________________

19 Spouse's Name
20 CNIC Number_________________________________________National Tax Number. __________________
21 Residential Address (if different from above): __________________________________________________
22 Tel.(Off) __________________Mobile #_________________ Fax # ____________Email. _________________
23 Present Occupation (Give full details)__________________________________________________________
24 Designation __________________________________ Name of Company /Employer ___________________
25 Monthly Income Gross ________________ Net ___________________ Pension (if retired)______________
26 Annual Income Gross ________________ Net ___________________

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Section C: Family Assets / Properties and Liabilities

1 Details of assets / Properties (Please mention current market values in Pak Rupees)

Values of Assets Father Mother Spouse Self Brother Sister Children Total
Business
Home/Flat
Agriculture Land/Plot
Car(s)/Bike(s)
Bank Balance
Investment
Others (etc)
Total

2 Accommodation Type:
Apartment Bungalow Town House Other

3 Accommodation ownership: Family Owned Rented Other

4 If owned, area of plot ConstructedConstructed


(Covered) area
(Covered)
of the house
area of the house
5 Locality of the house ______________________________________________________________________________________
6 Total number of rooms in house_____________ Number of bedrooms ___________________________
7 Number of Air Conditioners in house Number of Television

8 Number of car(s)/Bike owned by the family (with make and model)

9 Any other house or flat owned by the family: Yes No


If yes, please give details regarding location, size, rent, etc., on a separate sheet.
10 Agricultural land owned by family: Yes No
If yes, please give details regarding location, size, rent, etc., on a separate sheet.
11 Bank savings Rs. ______________________ in the form of ___________________________________
12 Other investments Rs. ___________________________ in the form of _________________________
13 Any other property or plots: Yes No
If yes, please give details regarding location, size, rent, etc., on a separate sheet.

14 Details of Liabilities (Please mention current market values in Rupees):

a) Amount Outstanding _____________________________________________________


b) Nature of Loan __________________________________________________________
c) Repayment Schedule (Please give full details) _______________________________
d) Laon / Debt Maturity Date ________________________________________________
e) Reason for Obtaining loan / debt __________________________________________
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1 Monthly Family Income (Please attach supports and give full details in Pak Rupees)

Average Montly Other


Income arising from Father Mother Spouse Self Brother Sister Supporting Total
Hand

Business
House/Flat
Agriculture Land/Plot
Car(s)/Bike(s)
Bank Balance
Investment
Others (etc)
Total

2 Annual Agricultural Income of Family _____________________________

3 Any other form of income from Assets or other ____________________

4 TOTAL FAMILY INCOME _________________________________________

5 Family Expenditure ( Please attach supports and give full details in Pak Rupees)
Provide details of family members currently studying (excluding the applicant). All costs should be mentioned in Pak Rupees
(attach a separate sheet, if required):
Annual Cost Annual Source of
Class Level Name of Academic of Education Financial Financial
Name Age
of Studies Institution/City of Study (Include all Assistance (if Assistance (if
Expenses) Any) any)

Provide details of family members (living with your family) that are not mentioned (attach a separate sheet, if required):

Name Age Relationship Qualification

a) Total number of Family members: b) Total number of Siblings:

c) Number of Siblings Married: d) Number of Siblings living with family:


e) Number of Siblings are Studying:
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6 Income and Expense Statement:


(A) Monthly Family Income Total (Rs.)

i) Family members’ earning (including the applicant).

ii) Income/support from other sources

Total family income (A(i) and A(ii)) A

(B) Monthly Family Expenditure

i) All Educational Expenses (excluding applicant)

ii) Accommodation/Rent

iii) Utility bills (Average Last Six Months)

Telephone / Mobile

Electricity

Gas

Water

iv) Household Expenses (food, etc.)

v) Medical

vi) Transportation/Fuel Consumption

vii) Income Tax

viii) Property Tax

ix) Any Other Expenditure (not mention above)

x) Miscellaneous (specify:__________________)

Total family expenditure (add B(i) to B(vii)) B

Net disposable Income (A minus B)

If the net disposable income is negative, i.e., expenditures are greater than the family income, provide
an explanation of how the family manages to meet this shortfall:

___________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

_________________________________________________________________________________

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Financial Need Analysis Form
Name:
Institution:
Course of study: Expected date of graduation:
Per Semester fee X
Academic Expenditures Yearly (Rs.)
No. of Semesters
1. Admission/Annual charges (excluding refundable amount)
2. Tuition fee (including non-refundable charges) _________ x _________
3. Examination fee _________ x _________
4. Books and Project material expenses _________ x _________
5. Transportation expenses from current residence to university*(university or public bus charges
to and from the campus)
*Don't include traveling cost such as air fare/bus fare for traveling from one city to another

BOARDING AND LODGING EXPENDITURES Monthly Expenses x Yearly (Rs.)


6.Hostel cost (for applicants living outside city of permanent residence) _________ x _________
7. Food cost (for applicants living outside city of permanent residence) _________ x _________
TOTAL EDUCATIONAL EXPENSES (add 1 to 7) A
FAMILY CONTRIBUTION AND FINANCIAL SUPPORT
a) Parental contribution
b) Bank/Co-operative society loan
c) Scholarship/Assistance from the institution/university
d) Others grants (please specify)_______________________
TOTAL CONTRIBUTION (add a to d) B
AMOUNT REQUESTED FROM IBA FOR ONE ACADEMIC YEAR
A-B
(Total Educational Expenses minus Total Contribution)
Have you applied for any other scholarship/loan from the university or other source(s)? Yes ( ) No ( )
If yes, provide details in the table below (attach a copy of the offer letter(s) or any evidence in support of the
same):
Funding Type Is the Funding
Expected Amount
Funding Source (Loan, Scholarship, Confirmed?
(Rs.)
etc.) (Yes / No)

If no, provide the reason(s):

How did you pay out this year's fees(i.e., admission fee, tuition fee, other charges, etc.)? Provide details below:
Source(s)* Amount (Rs.) Repayable (Yes/No)

*Sources: Self, savings, borrowing from relatives/family friends,loans, etc 8 / 10


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Statement of Purpose (Explain your suitability for this scholarship) - attach separate sheet if required:

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UNDERTAKING
The information given in this application is true to the best of my knowledge and I understand that any
incorrect information will result in the cancellation of this application. Further, If any information given
in this application is found incorrect or false after grant of financial assistance, the University will stop
further assistance and:

• The admission of the Applicant will be cancelled in case of 1st Semester students.

• In case of existing students, immediate repayment of the total Scholarship along with a fine
amounting to the Scholarship paid to the student will be required. Such a student will also be
disqualified for applying for any further loan / scholarship.

Date Signature of Parent / Guardian Signature of Applicant

References (Excluding Parents / Guardian):-

1. Name _______________________________________________________________________________

Relationship: ____________________________________________________________________________

Home Address ___________________________________________________________________________

Business Address ________________________________________________________________________

Contact Information: Residence: ______________ Office: ________________ Cell: ___________________

CNIC#: ________________________________Signature: _______________________________________

2. Name ______________________________________________________________________________

Relationship: ___________________________________________________________________________

Home Address __________________________________________________________________________

Business Address ________________________________________________________________________

Contact Information: Residence: ______________ Office: ________________ Cell: ___________________

CNIC #: _________________________________ Signature: _____________________________________

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