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: SADDAM HUSSAIN

CNIC No: 32203-2084843-7 Age: 19

Father's Name: Muhammad Ilyas

Gender: ✘ Male Female Domicile:

Email: sadamilyas@gmail.com Tel: 3238327608

Present Address: Room NO.142 Hamza Hall BZU Multan.

Permanent Address: Ward no 13 .Mohalla Sheikhan wala Leiah.

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: BZU Multan

Title of Programme / Course: DVM

Roll No: E-30 Registration No:

Programme started on: 27/08/2011 will complete on: 31/12/2014

Total Duration of your Programme / Course: Years: 5 Semesters: 10

Currently Enrolled in Year / Semester: 4th

Mode of Admission: Open Merit Reserved Seats ✘ Self Finance

Key person to be contacted in your department:

Name: Dr.Ali Buzdar

Designation: DSA Tel: 3006760406

ACADEMIC RECORD

Marks
Examination Year Roll No. Total Marks % Position
Obtained

Matriculation 2006 15329 781 1050 74.80 1st

Intermediate 2009 25027 837 1100 76.00 1st

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)

4th 7/1/2011 25-02-2011 2.67/4

GUARDIAN DETAILS

Name: Muhammad Ilyas

CNIC No: 32203-3784583-7 Relationship with Applicant: Father

Guardian's Occupation: Photo stat shop Yearly Income: 72000

Exact Designation: Organization:

Telephone: 3059651643 Address: Ward no 13 .Mohalla Sheikhan wala Leiah.

EDUCATIONAL EXPENDITURE

Current Expenses on Education

Yearly Messing
Yearly Tuition Fee Yearly Hostel Fee Total Expenditure
Expenses

56000 8000 20000 84000

Sources of Educational Financing other than Guardian's Monthly Income

Loan from Relatives / Friends

Loan from some organization LOAN FROM BANK

Scholarship from another organization

Remission from College / University

Income from other sources

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:

My mother takes loan from natonal bank of pakistan

Tuition Fee of Institutes Previously Attended

Matriculation Intermediate
GOVT MODEL SCHOOL
Name of the Institute KAROR(LEIAH) GOVT DEGREE COLLEGE LEIAH

Location

Yearly Fee 500 2500

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:

Average monthly electricty bills during the months April to Sept. 5000

Details of family members currently employed / retired

Yearly
Name Age Exact Designation Employer
Salary

SUGHRA BEGUM 50 teacher 9

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

TAHIR ILYAS 20 INDUS COLLEGE KARACHI 36000

LUQMAN ILYAS 16 GOVT MODEL SCHOOL LEIAH 500

AQSA BATOOL 8 AL-ATTA PUBLIC SCHOOL LEIAH 2000

ANAM RANI 17 KHAN COMMERCE COLLEGE 10000

Does your family / guardian own a piece of land, property, car/motor cycle or any other asset.

Provide complete details.

MOTOR CYCLE

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

MY PARENTS CAN NOT PAY MY FEE BECAUSE MY ALL SUBLINGS ARE STUDYING NOW. SO

I SHALL BE VERY THANKFUL TO YOU IF YOU WILL HELP ME

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.

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
For Diya's Office Use Only

Decision

Reason (if required)

History
Previous Folio
Last Disbursement
Required Docs

Disability Cert

Hifz Cert

Semester Results

Bachelor's Degree

Income Certificate

Siblings Fee Receipts

Flood Attestation