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					ANNEXURE-XIV

APPLICATION FORM FOR TUITION FEE WAIVER QUOTA IN B.E./B.TECH

(for Haryana Residents only who have appeared for AIEEE)

1. Name of the Candidate ________________________________________________________

2. Father’s Name ______________________________________________________________

3. Roll No. ____________________________ (TFW Roll No. can be generated from www.hscs.org &

the same has to be used for paying counseling fee of Rs.500/- through www.hscs.org )

4. AIEEE Roll No. (in case of B.Tech) _____________

5. Date of Birth :    Day Month Year




6. Gender: ___________

(Details for Sr. No. 1,2 & 4 to 6 to be filled as per admit card of respective course).

9. Contact Address: ______________________________________________________________

         _____________________________________________________________

 E-mail: _____________________         Phone No. _____________________________

10. Have you paid counseling fees Rs.500/- (non refundable) YES/NO _______________________

    If paid, name of Bank (PNB / Axis Bank) ________________________________________

(The photocopy of the proof of same is also to be attached.)

9. Parental Income from all sources: Rs. __________________

For B.E./ B.Tech AIEEE ranking and for B.Pharmacy OLET ranking will be used.

Note :

The candidate applying for Tuition Fee Waiver Category will produce Parents Income Certificate

from all sources from the organization where he and she is working or Affidavite of Income on stamp

paper from Notary (Annual income of Parents/Guardians should be less than Rs. 4.50 lakhs from all
sources). For details about TuitionFee Waiver Scheme, refer Appendix-I.

Attach attested copy of qualifying exam & 10th certificate.

Attach a copy of Haryana Resident certificate.



Declaration by the Candidate:

I declare that entry made by me in this application form are true in all respect and in case,

any entry or information is found to be false at any stage, this shall entail automatic

cancellation of my admission besides rendering me liable to such action as the

Institute/University/Board/State counseling board may deem proper. If the candidate is

allotted two seats, on the basis of General, TFW category, then student will deposit

admission fee against one seat of his/her choice and the another allotted seat will be

considered cancelled.

Place:                             Signature of Candidate

 Date:                             (Name of Candidate)

         Verification by Parent:    Signature of the Parent

				
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Description: Legal docs fro Addmission in Gharyana