NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR - 831014, JHARKHAND (An Institution of National Importance under MoE. Govt. of India, New Delhi) [APPLICATION FORM FOR REMISSION OF TUTION FEE FOR THE ACADEMIC YEAR 2022-2023 (Under MEMB-OEBC Scheme, Government of India) LAST DATE OF SUBMISSION: 19™ JULY, 2022 (TUESDAY) Noyeene 10. 1 2. 1B. 14. 15, 16. Name of the Applicant Institute Reg. No. Category (GEN/OBC/EWS) E-mail ID ‘Aadhar No. Contact No. (Mobile) Mailing Address [a] Annual Income of Family: RS. (including Father & Mother) for the FY 2021-2022 duly issued by the Competent Authority (sD0/Tahsildar/CO etc.) oR {b] (2) Annual Income of Father for the FY 2021-2022 : Rs. and (2) Annual income of Mother for the FY 2021-202; [ Duly issued by the Competent Authority (SDO/Tahsildar/CO ete.] Income from House Property : {a) Father Rs. (b) Mother Rs. Income from Agriculture Rs. (Both Father & Mother) Income from other sources: RS. (Both Father & Mother) Father’s/ Guardian's Occupation (if business, specify the type of business with valid proof, f any) ‘Mother's Occupation (jj Father's Name (ii) Aadhar No. of the fath (ii) PAN No. of the father {\v) Ration Card No. [attached copy of the Ration Card] (i) Mother’s Name (ii) Aadhar No. of the father (ii) PAN No. of the father {iv) Ration Card No. attached copy of the Ration Card] Bank Details of the Student: (Annexed photo copy of the pass book duly self attested) a) Bank account No. ig : b) Name of the Bank ¢)_ IFSC Code of the Bank Note: The Account should be in the name of Student only. No other name ‘will be entertaineDeclaration: We hereby declare that the statement given in the application form for remission of tution fee is true and correct with best of our knowledge and nothing has been concealed. Any change in my/our family income and other income hereafter will be informed to the Institute promptly Signature of the Father/Mother/Guardian Signature of the Student Place: Place: Date: Date: LST OF ENCLOSURES: 1. Family Income certificate of the parents (as per SI. No. 8 of the Application form for the FY 2021- 2022 duly issued by the Competent Authority (SDO/Tahsildar/CO etc.) 2. Document/Certificate of other income (as per SI. No. 9, 10 & 11 of the application form) 3. Certificates of employment both father and mother, if any (as per Sl. No. 12 & 13 of the application form) 4. Photo copy of Aadhar Card, PAN Card & Ration Card both father and mother, if any (as per SI. No. 14 and 15 of the application form). 5, Photo copy of the Student's Bank Pass Book (as per SL. No. 16 of the application form) 6. An affidavit on a Non-Judicial Stamp worth Rs. 100/- (Rupees one hundred only) deciaring as follows: We hereby declare that the statement given in the application form for remission of tution fee is true and correct with best of our knowledge and nothing has been concealed. Any change in my/our family income and other income hereafter will be informed to the Institute promptly. We further undertake that in the event of any of the particulars given in the application form being found fal ‘© The amount of exemption/waiver provided to the student will be refunded to the NIT Jamshedpur and disciplinary proceedings will be initiated to the extent of rustication from the Institute/ any other legal action deemed fit. ‘¢ The remitted amount will be refunded by me if | will indulge in any unfairmeans in any examinations. «© Lam not availing any other scholarships/ financial support from any other organization fro tution fees, The Institute also reserves. © the ~—sright «sto. get_— the information/credentials/particulars/certificates etc. with respect to the student and contents of the affidavit; verified by the concerned authorities i.e Income Tax Department (U/s 192 of IT ‘act1961; the Bank; BDO/ $D0/CO/Tahsildar/Gram Panchayat etc. ; Land record authorities; previous school he student has studied in etc. «I/we solemnly state that the fact mentioned in this affidavit and solemnly declared annual income if found false, is an offense and punishable under the Indian Penal Code and /we ‘am/are ready to accept any punishment under the Indian Penal code. Signature of the Father/Mother/Guardian Signature of the Student Place: Place: Date: Date: R OFF Ly (NIT JAMSHE ‘Amount paid in 1", 2", ‘Amount to be paid in 1%, 2%, | Amount to be | Remarks, ifany 15% 67" & B" Semester 3, a, 5 6" 7 & 8" | refunded Semester Signature of the Dealing Assistant Signature of the verifying Officer