AFFIDAVIT DULY NOTARIZED FOR FELLOWSHIP TO MINORITY STUDENTS PURSUING M.Phil/PhD

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1 In Rs.200 Non-Judicial Stamp Paper ANNEXURE -I AFFIDAVIT DULY NOTARIZED FOR FELLOWSHIP TO MINORITY STUDENTS PURSUING M.Phil/PhD I, (Name and age), son/daughter/wife of residing in (full address), is pursuing regular full time (M.Phil/Ph.D) course in University from (Date of Admission). I have applied for Directorate of Minorities Fellowship to Minority students pursuing M.Phil/Ph.D And I hereby affirm that: (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) (xiii) I belong to Minority Community I am a resident/domicile of State of Karnataka My age is less than 35 years when application is called for the fellowship I am not a Government or full time private Employee I shall submit all necessary documents as required by the Directorate of Minorities in future I am registered for regular and full time M.Phil/Ph.D courses in University/Academic Institution by fulfilling conditions of admission of that University/Institution. my/ parents or guardians annual income do not exceed Rs.6 lakh from all sources. I am not taking fellowship under any other source of the Central or State Government or any other body like UGC for the same study and course. I shall not claim any separate/fixed House Rent and Medical allowance. My all kinds of leave shall be approved by the University/Institute/College If I wish to leave the fellowship before the end of the tenure, the information regarding relinquishment will be informed to Directorate of Minorities. I shall submit feedback to Directorate of Minorities, in form of the report on the research work done. After completion of the research work the I shall submit two research papers (international/ national/ state level) published to Directorate of Minorities I shall complete my course successfully and I shall submit copy of final M.Phil/Ph.D certificate to Directorate of Minorities within stipulated time.

2 (xiv) (xv) My fellowship shall be cancelled: - If it is found that I have obtained Fellowship for minority students fraudulently, the cancellation should be automatic and the amount disbursed shall be recovered with at 12% interest per annum. - Concealment of facts and on any other ground of misconduct. - Unsatisfactory progress of research work or if I fail in any of the examinations related to Ph.D and M.Phil. - Candidate is later found ineligible on account of false information provided in the application submitted. - Candidate is already availing scholarship/fellowship from any other sources. - on non completion of the course successfully the fellowship amount disbursed shall be recovered with at 12% interest per annum The Directorate of Minorities reserves the right to withdraw/cancel the award without assigning any reason and decision of the Directorate of Minorities will be final This undertaking is submitted before the Director, Directorate of Minorities, 20th Floor, V.V. Towers, Dr. B.R. Ambedkar Veedhi, Bangalore On this day of month Signature of Parents Signature of the Candidate Before Me

3 In Rs.200 Non-Judicial Stamp Paper SURETY BOND DULY NOTARIZED ANNEXURE II 1) I S/O,D/O aged years residing at of District. 2) I S/O,D/O aged years residing at We the above mentioned persons do hereby affirm and stand surety to Sri/kumari S/O,D/O residing at for the Fellowship to Minority students pursuing M.Phil/ Ph.D sanctioned to him/her by the Government of Karnataka, Department of Minorities Welfare, Bangalore-01 for the year We are related to the candidate and we assure that Fellowship M.Phil/Ph.D amount so granted to the above candidate will be fully utilized for his/her studies. In case if the candidate discontinues his/her studies on his own, without informing the Government/Department, we assure that the amount of Fellowship so granted to the candidate, is liable to be refunded to the Government along with 12% interest per annum. If the candidate fails to refund the Fellowship amount so granted we will repay the entire amount on behalf of the candidate and stand surety for this amount. If we fail to refund the Fellowship amount so granted to our candidate the same amount can be recovered from us as arrears of land revenue. Signature of the Surety-1 (With fully Name and Address) Signature of the Surety-2 (With fully Name and Address) Before Me Date: Place:

4 ANNEXURE III STUDY CERTIFICATE TO BE ISSUED BY UNIVERSITY This is to certify that is working / studying for his/her full time regular (Ph.D/ MPhil) Course in the Department of, (Name & Address of University), on the topic of (Research / Thesis Topic) under the guidance of Professor (Name & designation of guide). Vide Registration No., Dated:. This is to certify that He/She is full time regular student and His/Her research work is progressing satisfactorily, and He/She is eligible to get fellowship under Directorate of Minorities Fellowship to Minority students pursuing M.Phil/Ph.D and He/She will abide and follow all the guidelines issued by Directorate of Minorities under this scheme. Signature Signature of the Signature of Head of Signature of Research Guide Department Registrar/Director/Principal Date (Seal) (Seal) (Seal of University/Institution/College Name of the Candidate

5 Government of Karnataka Minority Welfare Department Directorate of Minorities, Bengaluru. Ph.D & M.Phil Fellowship for Minority Students Date: Place: University Department of Attendance Certificate from to. Name of Research Scholar: Name of Research Guide: Contact No of Guide: Month/Date P-PRESENT S-SUNDAY GH-GOVT HOLIDAY O- OOD A- ABSENT C- CASUAL LEAVE Research Scholar Research Guide Chairman/ HOD

6 III PART - PART - II PART - I Directorate of Minorities Fellowship to Minority Students pursuing Ph.D / M.Phil File No: ORIGINAL DOCUMENTS TO BE PRODUCED DURING VERIFICATION Name: Course & Dept.: University: Name of Guide: Contact No.: 1. SSLC MARKS CARD Age Limit: 35 Years 2. PUC MARKS CARD 3. DEGREE MARKS CARDS OF ALL SEMESTERS 4. DEGREE CERTIFICATE/ CONVOCATION CERTIFICATE 5. POST GRADUATION MARKS CARDS OF ALL SEMESTERS 6. POST GRADUATION CERTIFICATE/ CONVOCATION CERTIFICATE 7. AADHAR CARD 8. DRIVING LICENSE/ VOTER ID/ RATION CARD/ PAN CARD 9. DOMICILE PROOF CERTIFICATE 10. AFFIDAVIT DULY NOTARIZED FOR FELLOWSHIP IN RS.200 NON JUDICIAL STAMP PAPER (ANNEXURE-I) 11. SURETY BOND DULY NOTARIZED FOR FELLOWSHIP IN RS.200 NON JUDICIAL STAMP PAPER (ANNEXURE-II) 12. PHD/MPHIL STUDY CERTIFICATE ISSUED BY UNIVERSITY (ANNEXURE- III) VALID CASTE AND INCOME CERTIFICATE (6 LAKH LIMIT) 13. Category Cat 1, 2A, 2B, 3B: Caste/Sub caste: 14. BANK PASSBOOK PASSPORT SIZE PHOTOGRAPHS SET SELF ATTESTED COPIES OF ALL DOCUMENTS PROVISIONAL ADMISSION CERTIFICATE/ ADMISSION LETTER/ 17. REGISTRATION CERTIFICATE TO MPHIL/PHD COURSE (MENTIONING FULL TIME REGULAR PHD/M.PHIL) 18. BONAFIDE CERTIFICATE 19. UNIVERSITY IDENTITY CARD 20. FEE PAID RECEIPT TO THE COURSE 21. PROGRESS REPORT OF THE RESEARCH WORK 22. PRE-PH.D COMPLETION OR COURSE COMPLETION CERTIFICATE 23. ATTENDANCE CERTIFICATE Students Studying in 24. HOSTEL/RENTAL AGREEMENT Universities out of Karnataka 25. NOC 26. JOINING REPORT 27. CONTINUATION CERTIFICATE Original Documents verified by- Name: Signature and Date:

7 Date of Counselling : Registration Date: Application to DOM Date: In University, Research Starting Date: Ending Date: IN DOM Fellowship Starting Date: Ending Date: AWARD LETTER From: To: Pending Documents REMARKS:

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