1

PRIME MINISTER’S SCHOLARSHIP SCHEME

ACKNOWLEDGEMENT SLIP
OFFICE COPY

Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.

Office Seal: (Signature of RSB)

Tear off Tear off

ACKNOWLEDGEMENT SLIP
STUDENT COPY

Your Application Form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.

Office Seal: (Signature of RSB)

Note: This copy duly stamped and signed by RSB given to the student by hand or by post.
(Envelope enclosed along with the application may be used.)
 2

MINISTRY OF DEFENCE
Department of Ex-Servicemen Welfare
PM’S SCHOLARSHIP SCHEME
FOR
DEPENDENT WARDS OF EX-SERVICEMEN / WIDOWS

Brochure-Cum-Application Form
For Academic Year 2009-10

Application Form consists of Col No 1 to 20, Renewal Form and list of RSB at state and
UT level. (Brochure-Cum-Application consists of 31 pages)

KENDRIYA SAINIK BOARD

West Block-IV, Wing-VII, 2nd Floor
R K Puram, New Delhi-110066
Website: www.mod.nic.in
Tele : 011- 26715250
E-Mail : jdpmscholarshipksb@gmail.com

Note: This application form (page number 13 to 22 alongwith required documents only)
is to be deposited by individual to RSB. Applications duly recommended by
RSB’s shall only be considered by KSB. Therefore, candidates are advised not
to forward applications direct to KSB as the same shall not be considered.
 3

PRIME MINISTER’S SCHOLARSHIP SCHEME

1. Introduction.

To encourage higher technical and professional education for the dependent wards of
ESM and their widows (below officer rank only) and dependent wards / widows of ex-
servicemen who died in harness due to causes attributed to military service,
irrespective of the rank, Prime Minister’s Scholarship Scheme has been introduced
from the Academic year 2006-07.

2. Scholarships Available.

A total number of 4000 scholarships will be allotted.

3. Students eligible for the scholarship.

(a) Dependent wards of ex-servicemen and their widows (below officer rank only)

(b) Dependent Wards/widows of ex-servicemen who died in harness due to causes

attributed to military service, irrespective of the rank.

(c) The scheme is open only for widows and wards of ESM.

Note: (i) The candidate irrespective of his marital status is eligible for PMSS. However,
an earning / serving candidate is not eligible.

(ii) For dependent wards of widows and widows of personnel died in

harness due to causes attributable as at (b), there will be no rank restriction.

4. How to Apply For Scholarship.

One candidate to submit only one application form for one course, if any
candidate submit two application for more than one course, both the
applications will be rejected. Forms are to be downloaded from the website
www.mod.nic.in. Application forwarded on any other format will not be considered.

Application to be forwarded on plain A4 size paper (typed or handwritten) in the

prescribed format duly completed in all respects with superscription on the envelope
“Prime Minister’s Scholarship Scheme.”

Documents to be attached alongwith PMSS application form are as follows:-

(a) Photocopy of ESM valid I card duly certified by RSB / ZSB.

(b) Extract of ESM discharge book as per specimen. (Refer page number 22)
(c) Matriculation certificate duly attested.
 4
(d) Minimum Entry Qualification certificate duly attested. (10+2 Marksheet or
full Graduation Marksheet which ever is applicable)

(e) Bonafide studentship certificate from Collage in original as per specimen. (Refer
page number 21)
(f) Demand Draft of Rs. 30/- not made before 20th December 2009.

Note: Failure to attach any above mentioned documents / certificate will lead to
rejection.

5. Selection Procedure.

Applications will be short listed based on Ex-servicemen category (as given in para 6)
and percentage of marks obtained in minimum entry qualification (MEQ).

6. PRIORITY for Grant of Scholarship.

Order of preference for allotment of scholarships will be as under:-

Category 1 Wards/ widows of defence personnel killed in action.

Category 2 Wards of ex-servicemen disabled in action and boarded out of

service with disability attributable to military service.

Category 3 Wards/widows of defence personnel who died while in service for

causes attributable to military service.

Category 4 Wards/widows of Defence personnel disabled in service with

disability attributable to military service.

Category 5 Wards of ex-servicemen in receipt of gallantry awards.

Category 6 Wards of ex-servicemen (PBOR).

7. Eligible Courses.

First year professional degree programme in BE, B Tech, BDS, MBBS, B Ed, BBA,
BCA, B Pharma, etc. duly recognized by the respective government regulatory bodies,
such as All India Council for Technical Education, Medical Council of India, UGC etc.
The scheme is open for courses mentioned above in recognized institutions (in India
only). Students studying abroad are not eligible for this scheme. Students getting
stipend for the professional degree course are also not entitled. The candidates may
avail only one time facility for first degree course (Professional) i.e. graduate
level only under PMSS.

8. Scholarship for Integrated Courses.

The facility under PMSS is restricted for professional courses only duly recognized by
the respective Government regulatory bodies such as All India Council for Technical
Education, Medical Council of India etc.
 5
9. Minimum Eligible Marks in 10+2 or Graduation.
(Minimum Educational Qualification for Entry) should be 60%.

Minimum educational qualification (MEQ) for entry to different professional course is

different e.g. for MBBS and B E it is 10+2 where as it is graduation for B Ed and MBA.
A candidate must have minimum 60% marks in MEQ to be considered for scholarship.

10. Duration of Scholarship.

Two to five years as approved by the concerned regulatory body (Except one year for
B Ed and five and half years for MBBS).

11. Amount of Scholarship.

a) The amount of scholarship would be as follows:

(i) Rs. 1250/- per month for boys Paid after successful completion of each
academic year.
(ii) Rs. 1500/- per month for girls

12. Renewal of Scholarship.

Candidate shall submit new Renewal Form along with two acknowledgement slip and
Bonafide Certificate duly signed by the Principal / Dean / Registrar of the institution /
college to the respective RSBs either in person or by post for renewal of scholarship
for the subsequent academic year. RSBs will scrutinize and check the application
forms and forward the same complete in all aspects to KSB immediately. RSBs
will issue acknowledgement slip to the candidates at the time of submission of the
application in person otherwise dispatch by post to them. Candidate to attach a self
addressed envelope, duly stamped to receive the acknowledgement of renewal
form by post. For easy comprehension an illustration has been given below:-

Student admitted in B Tech. September 2008

Marks in 10+2. 61%
Applied for PMSS. Before 31 December 2009
Finds his name in the list of 4000 successful candidates June 2009
selected for grant of PMSS.
Applied for first renewal of Scholarship by submitting first October 2009
year / first two semester result.
Granted first installment. December 2009
Applied for second renewal of Scholarship by submitting October 2010
second year / second two semester result.
Granted second installment. December 2010
Applied for third renewal of Scholarship by submitting third October 2011
year / third two semester result.
Granted third installment. December 2011
Applied for fourth renewal of Scholarship by submitting October 2012
fourth year / fourth two semester result.
Granted fourth installment. December 2012
* Dates given above are to illustrate an example for easy comprehension and the same
may not be quoted as authority.
 6

IMPORTANT INSTRUCTIONS FOR PM’S SCHOLARSHIP SCHEME

Incomplete form / pages / column / documents will lead to rejection or

returned to RSB unactioned.

(a) “PM SCHOLARSHIP SCHEME” is to be written in superscript on top of

the Envelope for any correspondence with KSB & RSB.

(b) Checklist duly signed by student & parent is to be attached on the top of the
application form.

(c) Applications alongwith relevant documents & certificates are to be deposited to

respective Rajya Sainik Board, “latest by 15th Feb 2010. Incomplete application
form and non submission of required document is liable to be rejected and will
be returned unactioned. The application will be received by the RSBs and will be
acknowledged with a seal and date of receipt.

(d) The concerned RSBs may scrutinise / check the application forms with
regard to their eligibility criteria from all aspects prior to forward the same to
KSB.

(e) Candidates and RSB’s to note that all applications received after the due
date will not be considered and returned unactioned.

(f) List of selected candidates will be forwarded to RSBs after the merit list is
finalized by the BOO at KSB.

(g) Three stamped (Rs. 5 each) blank envelopes of 27x12 cms and one stamped
(Rs. 35) blank envelope of 35x25 cms are to be attached with each application so as
to facilitate correspondence with the candidate by KSB/RSB.

(h) The scholarship is admissible for only two children of ESM. Particulars of
all children should be indicated in column 17 of application form. This should be in
uniformity with the discharge book / certificate of the ESM.

(i) The amount of scholarship, including any other scholarship or financial

assistance from any other source will not exceed the total grant of assistance available
under this scheme.

(j) The payment of scholarship will be granted after the successful completion of
each academic year and on the submission of the renewal form (in original), as per the
percentages mentioned in ‘Criteria for eligibility’. In case, KSB ask a student to submit
the mark sheet for the full year, a student is liable to produce the same, failing which
the scholarship will be held up.

(k) Candidature of a student shall stand automatically rejected if, at any

stage, it is discovered that he / she has secured scholarship fraudulently by
making false statement or misrepresentation of facts. Candidate shall have to
refund the amount already given, if any.
 7

(l) The attached photocopies of the supporting documents should be duly attested
by gazetted officer (unattested documents will not be considered). In case of
legally adopted son/daughter or child born after retirement, the certificates are to be
attached with the application form duly attested by Secretary, RSB / ZSB.

(m) If the marks in the qualifying examination are expressed in grades only, then
equivalent percentage (100 point scale) duly certified by the concerned college / Board
must be furnished (RSB & KSB will not be calculating the percentage of marks).

(n) All candidates to open individual bank accounts in the nearest State Bank of
India branch or Punjab National Bank which has “electronic clearance system” /
Core Banking, to facilitate transfer of the scholarship amount. Account number of the
sister concern bank will not be accepted. i.e State Bank of Travancore, State Bank
of Bikaner & Jaipur, etc. Candidate to attach a attested photocopy of passbook,
showing name and account number of the individual. A cancelled leaflet of a blank
crossed cheque will duly authenticate the account number. A joint account with
parent will also fulfill the requirement.

(o) The candidates should have secured a minimum of 60% marks at 10+2 / MEQ
level or equivalent and have to secure minimum of 50% marks, uninterrupted for
continuation of scholarship in every year for the duration of course up to a maximum
period of 5 years as prescribed for that programme of study. A person granted
scholarship for one programme would not be entitled for scholarship for another
programme.

(p) In case of change of any address, course, college, it is to be intimated

immediately to Kendriya Sainik Board & Rajya Sainik Board in writing. Always mention
selection serial number, name of applicant and ESM particular for any
correspondence with KSB & RSB after getting selected for the scholarship.

(q) The Ministry of Defence, Government of India can suitably modify these
instructions to remove anomalies, if any, for successful implementation of the
scheme, as may be necessary from time to time and will be applicable to all
students under the scheme.

(r) Ex-servicemen entitlement will be governed as per the existing definition of

ex-servicemen, as amended from time to time. The definition is available in the guide
book available with the RSB/ZSB.

(s) The application form should be downloaded from the official website of MOD,
i.e. www.mod.nic.in. The application form should be submitted to the respective
Rajya Sainik Board, (List of RSBs is attached along with the brochure) duly
completed, along with a Demand Draft (Repeat) Demand Draft only for Rs.30/- in
favour of Secretary, Kendriya Sainik Board, payable at New Delhi. In case of any
difficulty in obtaining the form, the same can be obtained from the Secretary / Director
Rajya Sainik Board. The Demand Draft should not be issued before 20th December
2009 (the Demand Draft is not refundable in any case).

(t) While filling the application form, leave 1 (one) box blank between 2 (Two)
words. Column wise guidelines are explained further for filling up the application form.
 8

COLUMN WISE GUIDE LINES FOR FILLING UP OF APPLICATION FORM

(i) Column -1. Fill your name as in matriculation certificate only:-

(Not to be filled in any other format.)

1st Name A J A Y
Middle Name S I N G H
Surname R A N A

(ii) Column -2. Put a tick (√) mark as shown.

Male √ Female

(iii) Column – 3. Date of Birth as shown in matriculation certificate only.

For Example:- (10 June 1982)

D D M M Y Y Y Y
1 0 0 6 1 9 8 2

(iv) Column – 4. Mention your Rajya Sainik Board and Zila Sainik Board name,
from where your father / mother have registered and have obtained ex-servicemen /
widow identity card.

(v) Column – 5. Write your permanent address and correspondence address in

block letters.

(vi) Column – 6. Write phone number along with STD code and email ID for any
query (email ID is must).

(vii) Column – 7. Category as per para 6 to be written (attach the required

document, if any). Category 1 (One).

Category - 1 O N E

(viii) Column – 8. Full Particulars of Father/ Ex-Serviceman is to be mentioned

as per the discharge book. A blank space to be provided between names.
(Example: - KAMLESH CHANDRA CHOUDHURY)
 9

K A M L E S H C H A N D R A C H O U D H U R Y

1 4 5 2 3 6 K

S E R G E A N T

A I R F O R C E

(ix) Column – 9. Details of 10+2 or MEQ. Leave blank space between words.
Marks to be shown in words and figures.

a. Total Marks O N E T H O U S A N D
(in words) T W O H U N D R E D
(in figure) 1 2 0 0

b. Marks obtained N I N E H U N D R E D
(in words) F O R T Y
(in figure) 9 4 0

c. % of marks scored S E V E N T Y E I G H T
(in words) P O I N T T H I R T Y
T H R E E
(in figure) 7 8 . 3 3

(x) Column – 10. Tick as applicable.

Yes √ No

(xi) Column – 11. The student is to specify the course which he / she is presently
studying. (Example:- B TECH)

B T E C H

(xii) Column – 12. Duration of the course both in numbers and figures to be
mentioned. For example 5 years 6 months.

(In figure)
 10
Y Y M M
0 5 0 6

(In word)
F I V E Y E A R S A N D S I X
M O N T H S

(xiii) Column – 13. Write date of commencement & completion of course as shown
below:

(Course Commencement / Date of Admission)

D D M M Y Y Y Y
0 1 0 7 2 0 0 7

(Course completion)
D D M M Y Y Y Y
3 1 1 2 2 0 1 2

(xiv) Column - 14 Write the full name and address of the college with email ID and
phone number of principal.
Name of Student A J A Y S I N G H R A N A

Roll No. 0 8 E A T I T 0 4 3

Name of College A J M E R I N S T I T U T E
O F T E C H N O L O G Y

Full Address P U S H K A R B Y P A S S A
of college J M E R

State R A J A S T H A N

Pin Code 3 0 5 0 0 4

Tel No. (with STD Code) 0 1 4 5 - 2 3 0 0 6 2 8

E-Mail ID (if any) a i t _ a j m e r @ r e d i f f m a i

l . c o M
 11

College Website w w w . a i t a j m e r . c o m

(xv) Column - 15 Write the regulatory body of your college.

A I C T E

(xvi) Column – 16. Furnish the particulars of your all children as per specimen
given:-

Sl. No. Name of Child Gender Date of Birth Age

1 Prakash Singh Rana M 10/10/1982 27 Years
2. Satish Singh Rana M 12/05/1984 25 Years
3. Ajay Singh Rana M 03/07/1987 22 Years
4. Komal Rana F 14/02/1989 20 Years

(xvii) Column – 17. Given details of the scholarship availed by your brother /
sister in the past, if not availed write Not Applicable.

Sl. Selection Name of the Course of Academic year Amount

No. Serial No. brother/sister Study in which received so far
given by KSB applied
1. 6359 Satish Singh Rana B Tech 2007-09 15000

(xviii) Column - 18 Please write the full details of bank account of the student and
attach the photocopy of passbook and cancelled cheque as required to verify the
correctness of the account number (individual student account is preferred. However,
a joint account with the father / mother is also accepted).

Name of account holder A J A Y S I N G H R A N A

Bank Name S T A T E B A N K O F I N D
I A

Branch Name A J M E R
 12
Branch Address A J M E R I N S T I T U T E O F T
E C H N O L O G Y

State R A J A S T H A N

Bank Tel. No. 0 1 4 5 - 2 3 0 0 6 2 2

Branch Code 0 5 1 4

MICR (9 digit) No. 5 1 8 0 0 2 0 0 7

(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No. 3 0 2 0 0 1 5 2 4 6 8

REPEAT

Account No. 3 0 2 0 0 1 5 2 4 6 8

(xix) Column – 19. Fill up attached Demand Draft particulars.

Issue D D M M Y Y Y Y
Demand Draft No. 0 2 3 1 5 0 Date 1 4 1 2 2 0 0 9

Amount (Rs.) in figure 3 0

Amount (Rs.) in word T H I R T Y

Issuing Bank Name S T A T E B A N K O F I N D I A

Issuing Bank Branch A J M E R

Note: Application form from page number 13 to 22 along with required

documents only to be forwarded.
 13
CHECK LIST OF DOCUMENTS TO BE ATTACHED WITH
THE APPLICATION FORM

1. Candidates / ESM are to ensure that the following documents are attached
(as applicable) along with the Application Form (non submission of these
certificate will lead to rejection and application will be returned unactioned).

(a) Attested copy of Ex-Serviceman/Widow I-card issued by RSB/ZSB.

This is an important document to be attached.

(b) Extract of ESM discharge book as per specimen.

(c) If child born after discharge then affidavit is to be submitted by ESM,

that child is dependent on him and he / she is a ward of ESM.

(d) Additional Certificates – Attested copy of following documents.

(i) Category 1: Part II Order Equivalent of other

(ii) Category 2: Part II Order services i.e. Army /
(iii) Category 3: Part II Order Navy / Air Force
(iv) Category 4: Part II Order
(v) Category 5: Award Certificate

(e) Attested photocopy of matriculation or equivalent examination

certificate for verification of date of birth.

(f) Attested photocopy of mark sheet of MEQ as applicable (e.g. 10 plus

2, graduation / diploma etc). In case the MEQ is graduation / diploma, then
complete mark sheet is required to be submitted.

(g) In case of MBA/MCA applicants, attested copy of minimum entry

qualification certificate. i.e Graduation

(h) Bonafide studentship certificate to be issued by

Registrar/Dean/Principal of College/Institution pertaining to course for which
scholarship is claimed (As per specimen attach).

(i) Demand Draft of Rs. 30/- (Rupees Thirty only) attached. (Application
form without Demand Draft will not be processed and Demand Draft
should not be made before 20th December 2009.)
 14

(j) Photocopy of passbook showing name, account number with

photograph of individual and cancelled leaflet cheque. (Scholarship will not be
sent in absence of photocopy of passbook)

Date: _____________________

_______________________________
Place: ____________________ Full Name & Signature of Candidate

_______________________________________
Checked / counter singed by ESM / Widow
 15

Selection Serial Number

......................
(To be allotted by KSB)
APPLICATION FOR PRIME MINISTER’S SCHOLARSHIP FOR THE YEAR 200_ - ___.

Recent
Note: 1.) Please read column wise guide lines carefully before filing the application Photograph
2.) Application Form to be filled in Capital letters except email ID.
3.) Checklist must be attached on the top of application duly tick marked.
Of Student
(Write your name
4.) One candidate to submit only one application form for one course.
& ESM/widow
particular on
reverse)
1. NAME:-
First Name

Middle Name

Surname

2. Put a tick mark (√) Male Female

3. Date of Birth (please attach proof of age) (i.e : Matriculation certificate)

DD MM Y Y Y Y

4. Your Rajya Sainik Board or Zila Sainik Board (Where ESM is registered and obtained Ex-
servicemen Identity card)

RSB

ZSB

5. Full Address:
a) Present Correspondence Address: - (Where you want your letter to be sent in case of
selection / rejection)
House No.

Street No. & Name

 16
LEAVE BLANK SPACE BETWEEN WORDS
Tehsil

District

State

Pin Code

b) Permanent Address :-
House No.

Street No. & Name

Tehsil

District

State

Pin Code

6. Telephone Number.

STD Code

Land Line No.

Mobile No.

E-Mail (mandatory)

7. Ex-servicemen Category - (Mention category as per Para 6 of the brochure and attach
supporting documents duly attested).

LEAVE BLANK SPACE BETWEEN WORDS

 17
8. Ex-serviceman’s Particulars:-

a) Name of ex-serviceman

b) Service No.

c) Rank

d) Type of Service (Tick one) Army Air Force Navy

9. Details of MEQ / course for qualifying examination for scholarship (10+2/equivalent

or minimum entry qualification)

a. Name of Course/MEQ

b. Year in which exam passed

c. Total Marks (in words)

(in figure)

d. Marks obtained (in words)

(in figure)

e. % of marks scored (in words)

(in figure)

10. Whether the applicant is in receipt of any other financial assistance/scholarship/ fellowship
from any govt. / Private source for the course to which the scholarship applied for. If yes, then
state the amount and source

Yes No

Amount

Source

11. Name of the Course

(as per specimen)

LEAVE BLANK SPACE BETWEEN WORDS

 18
12. Duration of Course in Years in figure
and months
in words

13. Date of Commencement and Approximate Date of Completion.

D D M M Y Y Y Y
a) Course commenced on

D D M M Y Y Y Y
b) Course completion date
approximately

14. Details of College / Institute.

Name of Student

Roll No.

Name of College

Full Address
of college

State

Pin Code

Tel No. (with

STD Code)

E-Mail ID (if any)

College Website

15. Regulatory bodies/ Council. (For example all engineering degrees and management
degree courses are recognized by AICTE & UGC and all medical degree are recognized
by Medical Council of India or Dental Council of India, specify as per case).

16. Furnish particulars of all children in order of age, as reflected in the discharge
certificate or attached by the RSB/ZSB/Record Office.

LEAVE BLANK SPACE BETWEEN WORDS

 19

Sl. No. Name of Child Gender Date of Birth

17. Details of brother/sister availing the PM’s Scholarship, if any. (Including yourself if
granted earlier)

Sl. Selection Name of the Course of Academic year Amount

No. Serial No. brother/sister Study in which received so far
given by KSB applied

18. Details of Student’s Bank account for payment of Scholarship through Electronic
Clearing Service.

Name of account holder

Bank Name

Branch Name

Branch Address

State

Bank Tel. No.

Branch Code

MICR (9 digit) No.

(PLEASE ATTACH A PHOTOCOPY OF CHEQUE & PASS BOOK)

Account No.

REPEAT

Account No.

LEAVE BLANK SPACE BETWEEN WORDS

 20
19. Details of Demand Draft.
Issue D D M M Y Y Y Y
Demand Draft No. Date

Amount (Rs.) in figure

Amount (Rs.) in word

Issuing Bank Name

Issuing Bank Branch

20. Declaration: “Certified that the particulars given by me in the application are correct
and any false statement made by us will disqualify me / my ward for award of PM’s
Scholarship Scheme, besides recovery of scholarship already paid. I also undertake to
abide by the conditions mentioned in the general instructions of the scheme.”

Place: (Signature of ward) ________________________

Date: (Full Name of Ward) _______________________

Place: (Signature of Parent) _______________________

Date: (Full Name of Parent) ______________________

CERTIFICATE FROM RSB / ZSB

“It is certified that PM Scholarship application form for academic year 20___ - ___ in
respect of Mr. / Ms. __________________________________________________________
S/o / D/o Ex -____________________________________________________ has been
checked, found correct as per check list provided by KSB and the applicant is eligible to apply
as per rules of the scheme”.

Office seal: Director, RSB / ZSB

Place : ________________

Date : ________________
 21
SPECIMEN COPY OF BONAFIDE CERTIFICATE

CERTIFICATE FOR PM SCHOLARSHIP

1. It is certified that Ms. / Mr ._____________________ is Bonafide

student of __________________________________ college. His / Her
roll number is __________ and he / she is studying in the I / II / III / IV /
V year or ______ semester of the One / Two / Three / Four / five years
_______________ course in ____________________ branch (if any).
He / she has joined this college in the academic year 20___ - ___ and
the course will be completed in the month of ____________ 20___
-___.

2. This is also certified that _____________ course is a professional

degree course and this college is approved by
________________________________________________.

3. This is also certified that student is getting Rs.__________________

(If not getting write N/A) stipend from this Institute / College or any other
sources. l

Office Seal: Signature of Principal / Dean / Registrar

Date:- ______________

Place:-_____________
 22

SPECIMEN COPY OF EX-SERVICEMEN CERTIFICATE

EX-SERVICEMEN CERTIFICATE
(In lieu of Discharge Book)

1. Type of Service (Army, Navy or Air Force) :

_______________________________________

2. Service No. :
_______________________________________

3. Rank :
_______________________________________

4. Name & Initials :

_______________________________________

5. Trade :
_______________________________________

6. Date of enrolment :
_______________________________________

7. Date of Discharge :
_______________________________________

8. Reason for Discharge :

_______________________________________

9. Duration/Length of Service :
_______________________________________

10. Regular :
_______________________________________
Reserve

11. ESM died on (if applicable) :

_______________________________________

12. Cause of death & :

_______________________________________
Whether Attributable

13. Particulars of dependent children:-

Sl. Name Gender Date of Birth
No.
1.
2.
3.
4.
5.
 23
6.
It is certified that the above information is duly checked from the discharge
book of Ex-servicemen and found to be correct.

Office Seal: Dir RSB/ZSB/OI/C Record Office

Date: ________________________

Place: ______________________

PRIME MINISTER’S SCHOLARSHIP SCHEME

ACKNOWLEDGEMENT SLIP
OFFICE COPY

Your Renewal form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.

Office Seal: (Signature of RSB)

Tear off Tear off

ACKNOWLEDGEMENT SLIP
STUDENT COPY

Your Renewal form dated_________ has been received on__________. The

application will be examined for eligibility. The dak receipt number ____________ is to be
mentioned for further correspondence with this office.
 24

Office Seal: (Signature of RSB)

Note: This copy duly stamped and signed by RSB given to the student by hand or by post.

Selection Serial Number......................

PROFORMA FOR RENEWAL OF SCHOLARSHIP UNDER PRIME MINISTER’S
SCHOLARSHIP SCHEME
(To be send only if selected for scholarship)
1. Name of the applicant (Ward/widow):

2. Selection serial No. given by KSB:

3. Particular of ESM:

Name of ESM

Rank
Service Number

4. Present address (where you want your letter is to be sent)

(To be filled up only in case of change from previous address or write N / A)
House No.

Street No. & Name

Tehsil & Post

Distt
RSB

Pin Code

5. Details of Bank account of SBI or PNB for Electronic Clearing Services ( (PLEASE ATTACH A
PHOTOCOPY OF PASS BOOK, CROSSED BLANK CHEQUE SHOWING YOUR ACCOUNT NUMBER TO
BE FORWARDED, EVEN IT IS SUBMITTED EARLIER).

Name of account holder

and account number
 25

Place: ________________________________

Date: Full Name & Signature of the ward / widow

It is certify that the information submitted by my child / Self is correct.

Place : _____________________________

Date : Full Name & Signature of the Parent

LEAVE BLANK SPACE BETWEEN WORDS

SPECIMEN COPY OF BONAFIDE CERTIFICATE FOR RENEWAL

CERTIFICATE FOR RENEWAL OF PM SCHOLARSHIP

1. It Is certified that Ms. / Mr ._____________________ is a Bonafide

student of __________________________________ college. His / Her

roll number is __________ and he / she is studying in the I / II / III / IV / V

year or ______ semester of the two / three / four / five years

_______________ course in ____________________ branch (if any).

He / she had joined this college in the academic year 20___ - ___ and the

course will be completed in the month of ____________ 20___ - ___.

2. This is also certified that Ms. / Mr. ___________________________

__________ has successfully completed his / her 1st / 2nd / 3rd / 4th / 5th year

and scored ________ % / Grade__________ (Total marks obtained were

_____________ out of ____________) and he / she is continuing the

course in 2nd / 3rd / 4th / 5th year .

 26
Office Seal:
Signature of Principal / Dean / Registrar

Date: ________________
Place: _______________

CHECKLIST FOR RENEWAL OF SCHOLARSHIP

DOCUMENTS TO BE ATTACHED:
(a) A Bonafide certificate from the College/Institute indicating that the candidate continues
to study in the subject course and showing his / her percentage of marks for which the
Prime Minister’s Scholarship has been sought (As per the specimen attach).

(b) Candidate to attach a self addressed envelope, duly stamped to receive the
acknowledgement of renewal form by post.

________________________________
Full Name & Signature of the Candidate

DEPTT OF SAINIK WALFARE/RAJYA SAINIK BOARDS

Sl No Address of RSB For Detail, Pl contact RSB

Port Blair-
Col KV Cherian (Retd)
Secretary 03192-235621 (O)
ANDAMAN &
Rajya Sainik Board 03192-235621(F)
1 NICOBAR
A & N Administration, Secretariat 03192-320360 (R)
ISLANDS (UT)
09434281518 (M)
Port Blair - 744 101
secrsbandnic@gmail.com
Hyderabad
Brig CS Vidyasagar (Retd)
Director 040-24736890 (O)
ANDHRA Deptt of Sainik Welfare 040-27990144 (R)
2
PRADESH Block IV, II Floor, Gruhakalpa 040-24747991 (F)
Complex, MJ Road, Nampally, 09440401470 (M)
Hyderabad - 500 001
apsainik@gmail.com
 27
Itanagar-
Shri K Kholie
Director 0360-2212282 (O)
ARUNACHAL
3 Dte of Relief, Rehabilitation & 0360-2290778 (R)
PRADESH
Settlement, Govt of Arunachal 0360-2212282 (F)
Pradesh, New Itanagar-791110 0360-2213615 (F)
09436041927 (M)
Guwahati-
Cmde K C Choudhury (Retd)
0361-2522229 (O)
Director
0361-2412196 (R)
4 ASSAM Dte of Sainik Welfare, Sainik
0361-2522229 (F)
Bhavan, Lachit Nagar
Guwahati - 781 007
dkc2000@rediffmail.com

Shri Md. Saood, BAS

Patna
Director
5 BIHAR 0612-2217301 (O)
Sainik Kalyan Nideshalaya
0612-2217301 (F)
Home Deptt, Old Secretariat
0612-2280333 (R)
Barrack No.10, Patna – 800015

Chandigarh

Lt Col Raj Kumar Singh (Retd) 0172-2701947 (O)

Zila Sainik Welfare Officer 0172-2700317 (O)
CHANDIGARH 0172-2726325 (F)
6
(UT) Zila Sainik Welfare Office (UT) 0172-2721064 (R)
Opposite Aroma Hotel, Sector-21- 09888880566 (M)
D, Chandigarh - 160 022

zswochd@gmail.com
Raipur

Col K L Yadav (Offg) (Retd) 0771-2445165 (O)

Director 0771-2427449 (O)
Deptt of Sainik Welfare, CG 0771-2352529 (R)
7 CHHATTISGARH
Near Collectorate Parisar, Behind 0771-2420084 (F)
Home Guard Office 09893164219 (M)
Raipur - 492 001

dsw.cg@nic.in
Delhi-
Gp Capt RK Sharma (Retd)
Secretary 011-23991876 (F)
8 DELHI Rajya Sainik Board 011-23969260 (O)
Opp Tis Hazari Court 09818953191 (M)
No.1, Rajpur Road, Delhi-110 054
rsbdelhi@nic.in
 28
Panaji
Maj Venugopal Nair (Retd)
0832-2227138 (O)
Secretary
0832-2443236 (R)
9 GOA Deptt of Sainik Welfare
0832-2227138 (F)
Collectorate Building
09420686834 (M)
Panaji - 403 001
secyrsbgoa@gmail.com
Gandhinagar

Lt Col Kishor Sinh Gohil (Retd) 079-23251295 (O)

Director 079-23251296 (O)
Distt Sainik Welfare office & 079-23251298 (O)
10 GUJARAT
Resettlement, Bachat Bhawan, 079-23251294 (F)
Ground Floor, Opp - Jyoti Sangh, 079-23245346 (R)
Relief Road, Ahmedabad-380001 079-25508539 (O)

rsb_guj@rediffmail.com
Panchkula
Brig KS Budhwar (Retd)
0172-2560462 (O)
Secretary
0172-2562102 (R)
Rajya Sainik Board
11 HARYANA 0172-2560462 (F)
Sainik Bhawan, Sector 12,
0172-2560321 (O)
Shaheed Capt Rohit Kaushal
09888527189 (M)
Marg, Panchkula - 134 109
sainikparivar@yahoo.com
Hamirpur-
Maj Jogi Dass Mankotia (Retd)
Director 01972-221854 (O)
HIMACHAL
12 Deptt of Sainik Welfare 01972-224659 (O)
PRADESH
Govt of Himachal Pradesh 01972-225961 (R)
Hamirpur - 177 001 01972-225643 (F)
09418090708 (M)
Jammu
Brig RS Langeh, VSM (Retd)
JAMMU AND Director 0191-2561547 (O)
13
KASHMIR Deptt of Sainik Welfare 0191-2465141 (R)
Ambphalla, Jammu - 180005 0191-2575362 (F)
09419180672 (M)
Ranchi-

Col AP Singh (Offg) (Retd) 0651-2330178 (O)

Director 0651-2330469 (R)
14 JHARKHAND
Sainik Kalyan Nideshalaya 0651-2331434 (F)
Ranchi (Jharkhand) 09431105964 (M)

jharkhand_skn@yahoo.in
 29
Bangalore-
Col CM Uthaiah (Retd)
Director
080-25589459 (O)
Deptt of Sainik Welfare &
080-28445706 (R)
15 KARNATAKA Resettlement,
080-25589459 (F)
Fd Mshl KM Cariappa, Bhavan,
09886205130 (M)
No 58, Fd Mshl KM Cariappa
Road, Bangalore - 560 025
sainikblr@rediffmail.com
Thiruvananthapuram

Shri KK Govindan Nair 0471-2304980 (O)

Director 0471-2472401 (R)
16 KERALA Deptt of Sainik Welfare 0471-2304980 (F)
Vikas Bhavan, 0471-2329279 (R)
Thiruvananthapuram - 695 033

govindan.nair@yahoo.com
Bhopal-
Brig Pramod Kumar (Retd)
Director
0755-2553992 (O)
Deptt of Sainik Welfare
0755-2666081 (R)
MADHYA Southern Shopping Centre
17 0755-2577209 (F)
PRADESH
09993030601 (M)
Guru Teg Bahadur Complex, TT
Nagar, New Market,
P.B.NO 364, Bhopal - 462 003
dirrsb@mp.gov.in
Pune-
Col Suhas S Jatkar (Retd)
020-26332763 (O)
Director
020-26332764 (O)
Deptt of Sainik Welfare
18 MAHARASHTRA 020-26850613 (F)
Maharashtra State ‘Raigad’, Opp
09422314276 (M)
National War Memorial, Solapur
Road, Ghorpadi, Pune-411 001
dsw@mahasainik.com

Lt Col H Sharat Singh (Retd)

Secretary
Imphal-
Rajya Sainik Board
19 MANIPUR
Sainik Rest House
09862672547 (M)
Opp. Lamphel Police Station,
Imphal-795004

Shillong-
Brig WJB Sturgeon, YSM, SM
(Retd) 0364-2225613 (O)
Director 0364-2536574 (R)
20 MEGHALAYA Dte of Sainik Welfare 0364-2225613 (F)
Public Service Commission 09436101551 (M)
Building Beyond DC Building
Shillong - 793 001
rsbmegha@rediff.com
 30
Aizawl-
Col John Zama, SM (Retd)
0389-2322732 (O)
Director
0389-2322732 (F)
21 MIZORAM Deptt of Sainik Welfare & Res,
0389-2325811 (R)
Tuikual ‘A’, PB No. 119
09436142593 (M)
Aizawl - 796 001
rsbmizoram@yahoo.in
Kohima-

Brig Brij Pal Singh (Retd) 0370-2270029 (O)

Secretary 0370-2270029 (F)
22 NAGALAND Rajya Sainik Board, Home Deptt, 0370-2221991 (R)
Home Br, Nagaland Civil Sectt., 09436830124 (M)
Kohima - 797 001

secyrsb-ngl@nic.in
Bhubaneshwar

Col (Dr) DK Das (Retd) 0674-2432268 (O)

Secretary 0674-2435998 (F)
23 ORISSA Rajya Sainik Board, Nageswar 0674-2721156 (R)
Tangi, Lewis Road, 09937940807 (M)
Bhubaneshwar-751002

rsbbbsr@gmail.com
Puducherry
Col Jacob Mathen Anand (Retd)
Director 0413-2253107 (O)
PUDUCHERRY Deptt of Sainik Welfare 0413-2250575 (F)
24
(UT) Jawan Bhavan Complex, Lawspet 09443228260 (M)
Main Road, Pakkamudayanpet,
Puducherry - 605 008
dswpuducherry@gmail.com
Chandigarh

Brig IS Gakhal (Retd) 0172-2701845 (O)

Director 0172-2740991 (R)
25 PUNJAB Dte of Sainik Welfare, Punjab 0172-2707345 (F)
Punjab Sainik Bhawan, Sector 09814297113 (M)
21-D, Chandigarh - 160 022

dswpb@rediffmail.com
Jaipur-

Col Phool Singh Mehla (Retd) 0141-2227897 (O)

(Offg) Nideshak 0141-2227650 (F)
26 RAJASTHAN Sainik Kalyan Vibhag 0141-2356464 (R)
Secretariat Building, North Block, 09314933120 (M)
Jaipur - 302 005

rajasthansainik@yahoo.com
 31
Gangtok-
Lt Col PB Gurung (Retd)
03592-202534 (O)
Secretary
27 SIKKIM 03592-221456 (O)
Rajya Sainik Board, Paljor
03592-202156 (R)
Stadium Road, Gangtok-737 101
03592-221456 (F)
09434448861 (M)
Chennai-

Capt S M Aslam, (Retd) 044-26691747 (O)

Joint Director 044-26691342 (O)
28 TAMIL NADU Dte of Ex-Servicemen’s Welfare 044-22331052 (R)
22, Raja Muthiah Salai, Choolai 044-26691886 (F)
Chennai - 600 003 09444823182 (M)

mdossc@gmail.com
Agartala
Lt Col Mohit Ghosh (Retd)
Secretary 0381-2326507 (O)
Rajya Sainik Board, Nehru Office 0381-2323795 (F)
29 TRIPURA
Complex, Gorkhabasti, P.O. 0381-2319005 (R)
Kunjaban, Agartala - 799 006 09436510584 (M)
West Tripura
rsb.tripura@gmail.com
Lucknow-
Shri AK Chaturvedi, PCS
(Additional Charge)
0522-2625354 (O)
UTTAR Director
30 0522-2625354 (F)
PRADESH Dte of Sainik Kalyan Evam
0522-2305107 (F)
Punarvas, Kariappa Bhawan,
0522-2391701 (R)
Kaiserbagh, Lucknow - 226 001
09415404142 (M)
Dehradun-
Brig AN Bahuguna, KC, YSM,
VSM (Retd) 0135-2744208 (O)
Director 0135-2743773 (F)
31 UTTARAKHAND Nideshalaya Sainik Kalyan 0135-2741481 (O)
Uttarakhan, Kalidas marg 0135-2670813 (R)
P O- Haathi Badkala 09358254621 (M)
Dehradun - 248121
dskddn@gmail.com
Kolkata-

Col PR Pal (Retd) 033-22141347 (O)

Secretary 033-22144643 (F)
32 WEST BENGAL Rajya Sainik Board, Block 'F' 033-22143220 (O)
(First Floor), Writers’ Building 09874535628 (M)
Kolkata - 700 001
rajyasainikboardwestbengal@gmail.c
om
 32
Note:

Dadar Nagar Haveli: ESM of these states can submit their Prime Minister application form to
Gujrat RSB.
Daman & Div

Lakshadweep: ESM of this state can submit their Prime Minister application form to
Kerala RSB.