Application: TEC MOL Pakistan Technical Scholarship Program [2014~2016] 1

1 Name Mr. / Miss. Ms.

2 Father’s Name Mr.

3 Union Council (Self)

4 Union Council (Father)

5 Domicile (Encircle One) Karak Kohat Hangu

6 District (Encircle One) Karak Kohat Hangu

7 Date of Birth / /19 Age on (30.01.2015) Years Months Days

8 Marks in SSC Total Marks: Obtained: Percentage:

9 Marks in FSc Total Marks: Obtained: Percentage:

10 Marks in 1st Year BE/ Geology/ DAE

Total Marks / CGPA: Obtained: Percentage:

11 Marks in 2nd year BE/Geology

Total Marks / CGPA: Obtained: Percentage:

12

Admission Status BE (5th Semester) Geology {5th Semester/3rd Year) DAE (2nd Year) Class / Roll # / Section

Name of Institution/Dept: _____________________________________ __ HOD/ Principal (Name): _____________________________________ _ Mailing Address: ____________________________________ __ _____________________________________ __ Contact Number: _____________________________________ __

13 Contact Numbers Self Father / Guardian

14 Postal Address

15 Permanent Address

1. Undertaking:

I Mr./Miss/Ms. S/D/O do hereby certify that I have personally filled out this form & the information is correct to the best of my knowledge & belief. If the information found incorrect, the award may be cancelled at any stage even after the selection & the company may also take up my case at any forum, it deems proper.

Signature of Applicant

2. Endorsement / Verification by HOD/Principal I hereby endorse & verify that the above information provided by the applicant for the subject scholarship {serial # 1 till 12} is true as per records available at this institution.

Name of HOD/ Principal Signatures & Official Seal

3. General Instructions 1. To be filled in block letters 2. Vital information {Name & Fathers Name } to be provided as in Secondary School Certificate 3. 2 Pass Port Size Photograph attested from back side 4. Copy of Self CNIC and/or Form B of the applicant along with CNIC of Father 5. Copy of all educational documents (attested by Head of Institute/Department ) 6. Endorsement by HOD/Principal of the Institute where the applicant is enrolled 7. Do Not Try To Influence the Selection Process at Any Stage 8. All those not meeting the criteria need not to apply 9. This form along with attached documents shall reach MOL Pakistan by 30

th January, 2015.

Passport Size

Pictures X 2

(Attested)