JITO SARVODAYA FOUNDATION
For Office Use Only
This programme is for economically underprivileged Jain family only.
1. Applicants Details:
Full Name: ______________________________________________________________________
Age: _______________ Years Gender: Male Female
Residence Address:
________________________________________________________________________________
________________________________________________________________________________
City: ________________________Pin Code: __________________
Contact Number: Mobile: _______________ Home: ________________
Educational Qualification:
Exam/cour Years Marks (%) School/College/Univer
se Completed sity
10th Name Of Entrance Score
12th Exam
Last
Degree (if
any) specify
2. Particulars of the course for which the assistance is required:
Name of the course: ____________________________________________________
Course Type: Part time Full time
Duration of the course: _____________________________
Admission Status: Confirmed Awaited
Date of commencement: ___________ Likely date of completion:
_____________________
Institution / University: __________________________________________________________
Address of the University/college/school:
________________________________________________________________________________
________________________________________________________________________________
3. Assistance Details:
Purpose (A) Amount
(Rs)
Tuition fees
Living expenses including
Hostel & Food expenses
Travelling Expenses
Others (specify)_________________
Total (A)
Assistance Required Rs. _____________
4. Provide details of any other loan/assistance from other institute/individual:
_____________________________________________________________________________
________________________________________________________________________________
5. Provide details of past assistance from JITO (if any): _________________________
6. Family Details:
Father’s/Guardian’s financial status/ family particulars:
Name: _________________________________________________________________________
Age: __________________, Occupation: ___________________________________________
Office Address: _________________________________________________________________
________________________________________________________________________________
City: _____________ Pin code: ___________ Contact details_________________________
Annual Income: _____________________
PAN Number: ______________ Number of dependents: ________________
Details of income of any other member of the family, if
earning:_______________________
Total annual income of the family: ______________________________
Residence: Owned Any Loan (please specify) ___________
Rental Monthly Rent (please specify) __________
In case my application is approved, please issue cheque in favour of
________________________________________________________________________________
Signature of Applicant Date:
Attachment Required:
1) All educational certificates,
2) Course application details including fees
3) Photo Id proof & address proof (election card/Driving license/ Adhaar card/
rationing card) of both applicant and Parent
4) Family income proof
Application Received by: _______________________________________
Signature: ____________
Application Received Date:
Application Verified by: _______________________________________
Signature: ____________
Application Verified Date:
Application approved by:
1) _________________________________________________________
Signature: ____________
2) ________________________________________________________
Signature: ____________
Date of Payment: ________________ Cheque no: ________________
RECEIPT
I, ___________________________________________ have received an interest free loan
of Rs. ____________ for education from JITO Ahmedabad chapter by cheque no.
________________ dated __________________.
Name: ____________________________________________
Signature: _________________________________________
DECLARATION
I, ___________________________________________ have received interest free loan for
education of my son/daughter _____________________________________ amounting
to Rs. ______________________ from JITO Ahmedabad Chapter. I am enclosing here
10 PDC’s for repayment of loan as per the following details:
Sr No Name of the Bank Cheque no Cheque date Amount
10
I here by confirm that above cheques will be honoured on due date without fail.
Cheque should be in favour of “Jain International Trade Organisation”
Signature:
Name:
Date:
