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. 10 & 11, for
application processing.

Fresh / Renewal (please specify % of fee waived off in case of renewal):

1. CANDIDATE’S INFORMATION

Name:
(First) (Middle) (Last)

Father’s Name: Alive/Deceased:

Guardian’s Name (if different): Relationship with Guardian:

DOB: Age: CNIC Number:

Marital Status: Gender:

District of Domicile: Province:

Present Mailing Address:

Permanent Mailing Address:

Residence Phone #: Applicant’s Mobile #:

Applicant’s Email Address:

2. ACADEMIC INFORMATION

Roll Number:
Degree Program: Year/Semester:

Previous Semester’s GPA (for continuing students): CGPA:

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

Bachelors

Intermediate
/A-Levels

Matriculation
/O-Levels

3. FAMILY INFORMATION

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

S. Name Relationship Age Marital Cell Occupation School/ Last

No Status Number Institute/ Qualification
Office/
Business

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 4. ASSETS

Item Quantity Current Value Registration Number

Air Condition

Car

Motor Cycle

Other Vehicle Specify:

Television

Computer/Laptop

Assets Father Mother Spouse Self Sibling 1 Sibling 2 Other Total

Specify: Specify: Specify:

Business

Home /Flat

Land/ Plot

Agricultural Land

Investments

Saving

Shares/securities

Gold and Silver

Bank Balance

House Rent Advance

Others

Total

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 Accommodation/ Property Details

Asset Title Exact Location Area Number of Number Current Ownership

(In Acres/ Bedrooms of Value
Sq. Rooms (Rs.) Owned by Joint Family,
Yards) Immediate Family. Rented
by Joint Family or
Immediate Family or If
other please specify
Bungalow

Apartment

Land

Plot

Commercial
property

Agricultural
Land

Town
House

5. 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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 6. INCOME

Annual Income Source Father Mother Spouse Self Sibling 1 Sibling 2 Other
(PKR.)
Specify: Specify: Specify:

Designation
Salary

Allowance

Annual Bonus

Salary Leave
Income Encashment
Others (Specify):

Total Gross
Salary
Tax

Provident Fund

Deduction Others (Specify):

Total Deduction

Net Salary
Annual Income

Business Annual Expenses

Income/
Agricultur
Agriculture
alIncome
Income
Total
Business
Income

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 Bank Deposit

Rental Income

Profit from
Other Saving/Investment
Income
Car(s) & Bike(s)

Others (Specify)

Total Other
Income

Total Annual Income

Total Family Annual Income

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
Education If Any Ifany

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 Utilities Expenditure

Month Electricity Gas Telephone Water Others Total

(Last 3months) Specify:

Average
Annual
Expenditure

Other Expenses

Legal Loan Repayment Donation Payment of Others Specify:

InsurancePremium

Total Annual Expense

Education Rental Transportation Household Medical Utilities Income/ Other

Expenditure Expenditure and Fuel Expenditure Expenditure Expenditure Property Expenditure
Expenditure (Ration etc.) (if any) Tax 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-BASIS ANALYSIS

Educational Expenses Per Annum in Rs.

Admission Fees

Tuition Fees (Including Student Activity Charges)

Books and Project material expenses

Transportation Cost (to and from University)

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 Type of Financial Is it Confirmed Estimated Amount Percentage of

Agency/Source Assistance TuitionFees
(Loan, Scholarship, etc.)

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 If No, Why:

How did you Pay last year’s/semester Fees?

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? - ATTACHSEPARATE 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/Guardian

o Siblings

o Spouse

o Guarantor

o Reference

• Copy of Domicile Certificate and Permanent Residence Certificate of

o Father /Guardian.

o Mother

o Applicant

• Copy of Student Identity Card

• Copy of SZABIST Tuition Fee Ledger Account (This will be issued by the Finance Department)

• 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

• Latest Income Tax Certificate and Return of all family members

• Last Six Months Bank Statement of all Family Members (All Bank Accounts)
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 • Documentation related to investments made

• Documentary evidence of any loans obtained

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

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

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

• Complete Photocopy of Passport of Applicant and Parents/ Guardian (All 36 pages)

• Address & picture(s) of current residence (Outside & Inside View)

• Medical Bills (If Applicable)

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

• Any other Document to strengthen the Case

11. TERMS & CONDITIONS

The scholarship will be terminated under the following conditions;

1. If the student fails to maintain a minimum SGPA ≥ 2.50 & CGPA ≥ 2.75.

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

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

3. If the 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.

4. If the student obtain F grade or withdraw any course.

Note:

 Please Email one PDF file of your filled scholarship form along with required documents to:
[email protected]

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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 andno 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 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 bythem.

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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