SZABIST Need-Based Scholarship Application Form

Instructions:
1. Please fill in BLOCK LETTERS
2. In case of non-applicable field, please write “NA”. Photograph
3. Provide the required documents, mentioned on Pg. 12 & 13, for application
processing.
4. Student must fill Online Portion of the Form as well on
https://forms.gle/gBVZEqwd2ekGpjDE9

1. CANDIDATE’S INFORMATION:

SANJAY
Name: __________________________________________________________________________________________________
KUMAR
(First) (Middle) (Last)

Father’s Name: ________________________________________

CHAMAN LAL Alive/Deceased: ___________________________________
ALIVE
Guardian’s Name (if different): ____________________________
NA Relationship with Guardian: ___________________________
NA
+923453712211
Father/ Guardian Cell Number: ___________________________Father/ [email protected]
Guardian Email: _______________________________

22-11-2002
DOB: __________________ 18
Age:________________ 44105-2154176-9
CNIC Number: ______________________________________________

SINGLE
Marital Status: ____________________________________________________ MALE
Gender: ______________________________

UMERKOT
District of Domicile: ______________________________________________ SINDH
Province: ______________________________

WELCOME CLOTH HOUSE; MARVI MARKET; UMERKOT

Present Mailing Address: ___________________________________________________________________________________

________________________________________________________________________________________________________

WELCOME CLOTH HOUSE; MARVI MARKET; UMERKOT

Permanent Mailing Address: _________________________________________________________________________________

________________________________________________________________________________________________________

+923453712211 Applicant’s Mobile #: _____________________

Residence Phone #: _________________ +923457586417 Mobile 2: ______________________
+923430005404
[email protected]
Applicant’s Email Address: __________________________________________________________________________________

2. ACADEMIC INFORMATION:

SZABIST Roll Number:

Degree Program: BS ARTIFICIAL INTELLIGENCE 2021/ FIRST SEMESTER

Year/Semester: ________________________________

86.18/ A-1
Previous Qualification Percentage/ Grade: _____________________________________________________________________

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Academic Qualifications
Type of Financial Amount Sponsoring
From To Grade/ Percentage/ Assistance/ Received Agency
Institutions Name
Level of Study Division CGPA Scholarship (If
(Year) (Year)
Any)

Master of
Science (MSc.)

Masters

Bachelors

Intermediate/A- THE SCHOLAR TWO YEARS THE SCHOLAR

PUBLIC HIGHER 2018 2020 A-1 86.18 EDUCATION FREE NA PUBLIC HIGHER
Levels
SEC: SCHOOL SEC: SCHOOL

Matriculation/ THE SCHOLAR

O-Levels PUBLIC HIGH 2016 2018 A 78.11 NA NA NA
SCHOOL UKOT

3. FAMILY INFORMATION

Particulars of Immediate Family Members * (use extra sheet in case of additional members)

S. Name Relationship Age Marital Occupation School/ Last Monthly

No Status Institute/ Qualification Income
Office/
Business

1 MARRIED COMMISION COMMISION

CHAMAN LAL INTERMEDIATE
FATHER 46 AGENT SHOP 32000

2
MARRIED
UTMI KUMARI MOTHER 38 HOUSEWIFE NA 5TH CLASS NA

3 THE SCJHOLAR
DEVDAS BROTHER 17 SINGLE STUDENT PUBLIC HIGH 10TH CLASS NA
SCHOOL UKOT

4 GOVT: HIGH
14 STUDENT SCHOOL NA
PARDEEP KUMAR BROTHER SINGLE 8TH CLASS
BACHABAND
5 GOVT: HIGH
13 SINGLE STUDENT SCHOOL
LAKSH KUMAR BROTHER 8TH CLASS NA
BACHABAND
6

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 4. INCOME

Sibling 1 Sibling 2 Other

Annual Income Source Father Mother Spouse Self Specify: Specify: Specify:
(Rs.)

Designation

Salary

Allowance

Annual Bonus
Salary
Income Leave
Encashment

Others (Specify):

Total Gross
Salary

Tax

Provident Fund
Deduction
Others (Specify):

Total Deduction

Net Salary

Annual Income

Business Annual Expenses

Income/
Agriculture Agricultural
Income Income

Total Business
Income

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 Pension

Bank Deposit

Rental Income
Other
Income Profit from
Saving/Investme
nts

Car(s) & Bike(s)

Others (Specify)

Total Other
Income

Total Annual Income

Total Family Annual Income

Total Monthly Income

Total Family Monthly Income

5. ASSETS

Item Quantity Model Capacity (Ton, CC, Current Value(s) Registration

etc.) Number(s)

Air Condition

Car

Motor Cycle

Other Vehicle Specify:

Television

Computer/Laptop

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 Father Mother Spouse Self Sibling 1 Sibling 2 Other Total

Specify: Specify: Specify:

Assets (in Rs.)

Business

Home /Flat

Land/ Plot

Agricultural Land

Investments

Saving

Shares/securities

Gold and Silver

Bank Balance

House Rent Advance

Others

Total

Bank Account Details of all family Members (Last Six Months):

In the Name off Name of the Bank Opening Balance Total Credit Total Debit Closing Balance

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Accommodation/ Property Details

Asset Title Exact Location Area (In Number Current Monthly Ownership/ Tenant
Sq. Foot) of Value (Rs.) Rent (If
Bedrooms Applicable) Owned by Joint Family,
Immediate Family. Rented by
Joint Family or Immediate
Family, Employer Given or If
other please specify

Bungalow

Apartment

Land

Plot

Commercial
property

Agricultural
Land

House

6. LIABILITIES

Amount Outstanding

Nature of Loan

Repayment Schedule (Please give full details)

Loan / Debt Maturity Date

Reason for Obtaining loan / debt

Any Other Liabilities (Specify)

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 7. EXPENDITURE

Education Expenditure (use extra sheet in case of additional members)

Name Relationship Age Class Annual Other Annual Source of

Level Cost of Expenses Financial Financial
School for Assistance Assistance If
Education If Any any

Utilities Expenditure

Month (Last 3 Electricity Gas Telephone Water Others Specify: Total

months)

Average Annual
Expenditure

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Other Expenses

Legal Loan Repayment Donation Payment of Insurance Others Specify:

Premium

Total Annual Expense

Education Rental Transportatio Household Medical Utilities Income/ Other

Expenditure Expenditure n and Fuel Expenditure Expenditure Expenditure Property Tax Expenditure
Expenditure (Ration etc.) (if any)
Specify:

Income/ Expenditure Table

Total Annual Income

Total Annual Expenditure

Net Annual Disposable Income

If the net disposable income is negative, provide an explanation of how the family manages to meet the shortfall:

________________________________________________________________________________________________________
________________________________________________________________

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 8. SZABIST NEED- BASED SCHOLARSHIP REQUEST FORM FOR FALL 2021 & SPRING 2022

Educational Expenses Per Annum in Rs.

Admission Fees

Tuition Fees (Including Student Activity Charges)

Books and Project material expenses (If Any)

Transportation Cost (to and from University) (If Any)

Total Education Expenses

Lodging and Boarding Per Annum in Rs.

Hostel cost (for applicants living outside city of permanent residence)

Food cost (for applicants living outside city of permanent residence)

Total Lodging and Boarding Expenses

Family Contribution and Other Sources Financial Support Per Annum in Rs.

Family Contribution

Bank/Co-Operative Society Loan

Scholarship/Assistance (please specify: )

Other Sources (please specify: )

Total Contribution

Amount Requested from SZABIST

Percentage of Tuition Fee

Have you applied for any other scholarship/loan from the university or other source(s): __________________________________

If yes, provide details in the table below

Sponsoring Agency/ Type of Financial Is it Confirmed Estimated Amount Percentage of Tuition

Source Assistance (Loan, Fees
Scholarship, etc.)

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If No, Why:

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

How did you Pay last year’s Fees (In case of new Admission your last year in the previous qualification)?

Sources Amount Is it repayable?

How do you plan to pay fees if your SZABIST Need-Based Scholarship Request is not Accepted?

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

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 9. STATEMENT OF PURPOSE AND WHY SHOULD WE AWARD YOU THIS SCHOLARSHIP? - ATTACH
SEPARATE SHEET IF REQUIRED:

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 10. DOCUMENTS TO BE SUBMITTED WITH THE FORM

The mentioned below documents are mandatory and should be attested by Gazette Officer (B-17) & above

 Copy of CNIC of (In Case under 18 years of Age B-Form):

o Applicant

o Mother

o Father

o Guardian (If Different)

o Siblings

o Spouse

o Guarantor

o Reference

 Copy of Domicile Certificate and Permanent Residence Certificate of

o Father

o Guardian (If Different)

o Mother

o Applicant

 Copy of SZABIST Admission Letter

 Copy of Paid SZABIST Admission Fee Challan/ Voucher

 Copy of academic certificates of previous qualifications

 Copy updated Resume/ C.V of applicant

 Copy of Latest fee challans/Fee concession (scholarship/loan) document(s) of all family members studying

 Copy of Fees of Previous Education and Scholarship Documents

 Copy of Salary Slip/pension book of all working family members

 In case, any family member is a non-salaried person i.e. Business man / Landlord etc., provide;

o Bank Statement of last six (6) months business account.

o Copy of Income Assessment / Return of Income duly issued by Income Tax Department, Government of Pakistan

o If Not a Tax Filer Income Certificate issued by District Commissioner

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  Latest Income Tax Certificate and Return of all family members

 Last Six Months Bank Statement of all Family Members (All Bank Accounts)

 Copy of Documentation related to All Assets

 Documentary evidence of any loans obtained

 Copy of accommodation/house documents (Rent Agreement if Rented Otherwise Property Papers)

 Six Photographs of all properties owned and rented (3 from Outside and 3 from Inside)

 Copy of documentary evidences of investments/real estate/property owned by the family

 Copies of latest Utility Bills: Electricity, Gas, Telephone, Mobile, etc.

 Medical Bills (If Applicable)

 Copy of Passport of All Family Members (All Pages) (If Made)

 Death certificate (if / whenever applicable) of parents, siblings & spouse (if any)

 Vaccination Card/ Certificate

 Any other Document to strengthen Case

11. TERMS AND CONDITIONS

The scholarship will be terminated in the following conditions;

1. If the student fails to maintain minimum CGPA of 2.5.

2. If the student fails to maintain minimum 80% attendance in class (Maximum 3 absences for courses of 3-hour duration

and maximum 6 absences for courses with 1.5-hour duration)

3. If student is punished because of his / her involvement in violation of the institute’s rules, damage to institute’s property,

misbehavior with staff or students, or any other disciplinary violation.

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 12. DECLARATION AND UNDERTAKING

1. I hereby solemnly declare that the above details provided by me are truthful and accurate to the best of my knowledge and
no part of the information is concealed or deliberately left out.

2. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion,
complaint to HEC and cancellation of Scholarship and asked to immediately refund the scholarship amount if any of the
submitted information or supporting documents is found to be false.

3. I also agree to accept the decision of the SZABIST Award Committee concerning the evaluation of my application for
Scholarship.

4. I allow SZABIST the right to use information given in this form for verification and other purposes deemed necessary by
SZABIST.

__________________ ____________________________ ____________________ ____________________

Date Father/Guardians Signature Mothers Signature Applicants Signature

Guarantors & Reference (Excluding Immediate Family Members): -

Guarantor 1 Name _________________________________________________________________________________________

Relationship: _____________________________________________________________________________________________

Home Address ____________________________________________________________________________________________

Office Address ____________________________________________________________________________________________

Contact Information: Office: _________________________________________ Cell: ____________________________________

CNIC#: __________________________________________Signature: ________________________________________________

Reference 1 Name _________________________________________________________________________________________

Relationship: _____________________________________________________________________________________________

Home Address ____________________________________________________________________________________________

Office Address ____________________________________________________________________________________________

Contact Information: Office: _________________________________________ Cell: ____________________________________

CNIC#: __________________________________________Signature: ________________________________________________

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