APPLICATION FOR IPA BENGAL PHARMA & HEALTHCARE TRUST SCHOLARSHIP
(FOR THE SESSION 2024-2025)
To
The Secretary
IPA Bengal Pharma & Healthcare Trust
Trinayani Apartment, 1st Floor, 22 B, Panchanantala Road
Kolkata - 700 029
Sir,
I am furnishing below the required detail for considering my candidature for the IPA BENGAL PHARMA
& HEALTHCARE TRUST SCHOLARSHIP,2025
Thanking You,
Yours faithfully,
Date:
(Signature of the Applicant)
I. PERSONAL DETAIL
1. Full Name (In Block Letter): Mr. / Ms. …………………………………………
2. Contact No.: ………………………………………………..
3. E-Mail Id.: ………………………………………………………
4. Father’s Name: ……………………………………………………………………….
5. Address For Correspondence:…………………………………………………
…………………………………………………………………………………………………
………………………………………………………………………………………………….
6. Date of Birth …………………… 7. Nationality ……………………………
8. Year of Study: Diploma in Pharmacy 2nd Year / B.Pharm 2nd Year/
B.Pharm 3rd Year/ B.Pharm 4th Year
(Strike out which are not applicable)
9. Bank Account ( Applicant) Detail:
Name of Bank ……………………………………………………………………..
Branch: …………………………………………………………………………..
IFSC:………………………..A/C No……………………………………………
10. Member of IPA / Other Professional Organisation: Yes /No
If yes,
Organisation name:
Membership no:
11. EDUCATIONAL QUALIFICATIONS (As applicable)
Examination Passed University/Board/Council Year of Marks/Grade Point Obtained
Passing
Diploma in Pharmacy
Part-I (for 2nd year
student)
Odd Even Total/YGPA
Sem Sem
B.Pharm 1st and 2nd
Semester ( for 2nd
year student)
B.Pharm 3rd and4th
Semester( for 3rd year
student)
B.Pharm 5th and 6th
Semester( for 4th year
student)
THE RELEVANT MARK-SHEET IS/ARE ATTACHED HEREWITH
II COLLEGE DETAIL
10. (a) Name of College:…………………………………………………………….
(b) Address : …………………………………………………………………………………………….
…………………………………………………………………………………………………………..
© Telephone No.:…...............................Fax No.:……………..E-mail:………………………………..
11. Principal’s / H.O.D.’s Name: ………………………………………………………………………
DECLARATION BY THE APPLICANT
(i) I hereby declare that the information given by me is correct.
(ii) I shall abide by the terms & conditions for sanction of the scholarship.
Date: (Signature of the Applicant)
Place:
Recommendation of the Principal/H.O.D
This is to certify that Mr./Ms. ………………………………………………….Son/daughter of
…………………………………………………………………………is a student of our institution
and presently he/she is studying in 2nd Year of Diploma in Pharmacy Course /………….Year of
Bachelor of Pharmacy Course.
His/her attendance in the college is ………%
I recommend him/her for the scholarship.
Office Seal
Signature of Principal/H.O.D
RULES:
1. The Scholarship will be awarded to students who are currently studying at any Institution in West
Bengal and approved by PCI in the 2nd year Diploma in Pharmacy and 2nd , 3rd and 4th Year Bachelor in
Pharmacy Course in the Academic year 2024-2025 .
2. The applicant is advised to send the completed application in prescribed format along with relevant
mark sheet either in ordinary post /hand delivery/ drop box of IPA & IPA Trust in IPA office.
3. No application through mail will be allowed. The decision taken by the Trust will be treated as final.
No correspondence/ discussion will be entertained . IPA members will be preferred.
4. The selected awardees are required to be present on a day in March’ 2025 (exact date will be
communicated later) in the IPA auditorium to receive the award ( Account payee cheque) in person.
5. The last date for submission of completed application is 28th February, 2025
………………………………………………………………………………………………………..
For official (IPA Trust) use only
Sl. No. of Application ……… Diploma 2nd Year. B.Pharm 2nd /3rd /4th Year
Name of Institution ……………………………………………………………………..
Score on Academic Performance:
IPA Membership No.: ……………. Date of submission of application for membership:…………
Total Score :………………………
