Instructions:

1 – Fill in the form completely and do not leave any column blank. If any column is not applicable to your case, specifically
‘Nil’.

2 – Attestations and other documents are not required at this stage; simply fill-in the form and submit via email.

3 – Any false statement or incomplete information will make you ineligible.

Guidelines:

1 – Personal Details:

Your name must match with the exact name printed on your CNIC.

Make sure that your CNIC number is absolutely correct.

We’ll prefer to have your personal mobile number listed here.

2 – Course Details

State the exact title of your programme like MBBS, BE Electrical, BS Information systems etc.

Course beginning and completion dates mean the time period starting from your enrollment in university / college to your
expected graduation.

Let us know very clearly which semester or year you are currently enrolled in.

3 – Academic Records

Examination Level means different stages of your programme like 3rd semester, 2nd Prof or 1st year etc.

List all semester / yearly / professional examinations that have been held since your enrollment and whether you have pas
those or not.
If the result has not been declared for your recent exam, then say ‘Not declared yet’ in the results status column.

4 – Guardian Details

You are required to provide specific details of your guardian’s occupation. Whether employed or retired, you should state h
exact designation and organization. Do not provide vague statements like ‘Government servant’.

If your guardian is engaged in a commercial activity or self-employed, e.g. if he is farmer or shopkeeper, then provide deta
his farm / business in the relevant section of Household Details.

Make sure to state your guardian’s yearly income from all sources.

5 – Educational Expenditure

If you possess sources of financing other than guardian’s monthly salary / income, then you must state its amount in the
relevant column. Say ‘Nil’ for columns that do not apply.

If your guardian’s income can be broken down into fixed salary and other income, such as rental income from property etc,
then you must state these other sources in the space provided here.

As for the educational fee of the institutes previously attended, quote the sum of yearly tuition fee and hostel charges (inca
you were living in a hostel).

6 – Household Details

Family members include father, mother, brothers and sisters.

You must state the yearly figures for all salaries, earnings and fee.
 DIYA PAKISTAN REGISTERED
1304/474, Hasan Street, Defence Road, New Lalazar, Rawalpindi
Tel: 051-5859582, Mobile: 0300-5322592
(Office Telephone Timings: 3:00pm to 5:00pm)

This Form must be submitted via email to apply@diyapak.org

APPLICANT'S DETAILS

Name: uzair azam

CNIC No: 35402-0387282-9 Age: 21

Father's Name: muhammad azam

Gender: ✘ Male Female Domicile: nankana sahib

Email: uzair_khan7265@yahoo.com Tel: 3137265181

Present Address: room no.51 hostel islamic centre punjab university new campus lahore

Permanent Address: ward no. 12 near vocational training institute tehsil more nankana sahib

Applicant's Status: Orphan Disabled ✘ Poor & Deserving

Orphan's Only: Mention year of father's death:

Disabled Only: Indicate nature of disability:

COURSE DETAILS

Name of University / College: punjab university

Title of Programme / Course: B.S(hons) GEOLOGY

Roll No: 49 2007-UGD-45

Programme started on: 22-09-2007 will complete on: 22-09-2011

Total Duration of your Programme / Course: Years: 4 Semesters: 8

Currently Enrolled in Year / Semester: 6th semester

Mode of Admission: ✘ Open Merit Reserved Seats Self Finance

Key person to be contacted in your department:

Name: Dr.Nasir Ahmad

Designation: director Tel:

ACADEMIC RECORD

Marks
Examination Year Roll No. Total Marks % Position
Obtained

Matriculation 2004 120340 618 850 71.76 1st devision

Intermediate 2007 8276 779 1100 70.82 A grade

Bachelors

Are you Hafiz-e-Quran? ✘ Yes No

Do you retain Hifz? ✘ Yes No

Current Academic Performance

Provide complete details of all examinations that have been administered by your university / college
so far, including examinations for which the result has not been declared yet.

Examination Level
Month / Year when exam Results Declaration Date Average Percentage or
(Mention Year, Prof or
was conducted / Status GPA obtained
Semester)

1st semester 8-Feb-08 1-Apr-08 3.08

2nd semester 8-Aug-08 1-Sep-08 2.58

3rd semester 10-Feb-09 5-Apr-09 2.74

4th semester 10-Aug-09 5-Sep-09 2.67

5th semester 15-Feb-10 20-Apr-10 2.11

6th semester In progress

GUARDIAN DETAILS

Name: muhammad azam

CNIC No: 35402-5288638-3 Relationship with Applicant: father

Guardian's Occupation: private job Yearly Income: 100000

Exact Designation: accountant Organization:

Telephone: 3227958275 Address: ward no. 12 near vocational training institute tehsil more nankana sa
EDUCATIONAL EXPENDITURE

Current Expenses on Education

Yearly Messing
Yearly Tuition Fee Yearly Hostel Fee Total Expenditure
Expenses

9670 8000 24000 41970

Sources of Educational Financing other than Guardian's Monthly Income

Loan from Relatives / Friends no

Loan from some organization no

Scholarship from another organization no

Remission from College / University no

Income from other sources no

If you are receiving scholarship from another organization, then please provide the details of this
scholarship:

Name of the Donor / Organization:

Type of Scholarship: One-time Yearly Monthly

If you have stated any amount for 'Income from other sources', then provide complete details of all
such sources:

Tuition Fee of Institutes Previously Attended

Matriculation Intermediate
Govt.M.C Primary school nankana
Name of the Institute sahib Govt.GURU nanak degree college

Location Nankana Sahib Nankana Sahib

Yearly Fee 200 300

Amount of any
Scholarship / Remission
Availed
Note: For matriculation you should state the yearly expenses you had to incur in class Xth only.
Similarly, for Intermediate you should state the yearly expenses of class XIIth only.

HOUSEHOLD DETAILS

Family Accommodation Details:

Note: Family includes father, mother, brothers and sisters.

Type: House Flat ✘ Quarter Mud House

Status: ✘ Rented Family Owned Provided by Govt. / Organization

If rented, annual rent: 24000

Average monthly electricty bills during the months April to Sept. 400

Details of family members currently employed / retired

Yearly
Name Age Exact Designation Employer
Salary

Muhammad Azam 55 accounatnt 100000

Details of family members currently engaged in business / commercial activity

Yearly
Name Age Type of Business Location of Business
Earnings

Details of family members currently studying

Name Age Institute Yearly Fee

Umair Azam 22 M.A (punjab university ) 2500

Zuniar Azam 18 Wah engineering college 24000

Shanza Azam 15 hira college 1000

Any other thing that you would like to add or say (related to this application):

Sir I m very poor student and belong to poor family. I need financial add.

Declaration by the Applicant and his/her Guardian:

We, the undersigned solemnly affirm that the details/information

provided are accurate and that we shall be responsible for
any inaccurate or false information.

UZAIR AZAM MUHAMMAD AZAM

Applicant's Signature Guardian's Signature

Verification by Tehsildar or Competent Authority:

I attest that the information contained in application form is accurate

and the applicant deserves the grant of scholarship award.

Signature Stamp / Seal

Note: Competent authority includes Area Magistrate, Tehsildar, Naib Tehsildar, Mukhtiarkar or
Area Nazim
kana sahib
For Diya's Office Use Only

Decision

Reason (if required)

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