Education Assistance Application Form

Read the instructions carefully and submit all necessary details.

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Only fields marked in ^* are mandatory. You may skip the other fields, yet we recommend to add as much detail as possible to support your application.

Student Details

Student Surname*

First Name*

Middle Name

Complete Residential Address *

Aadhaar No*

Date of Birth *

Gender*

Male

Female

Other

Current Class / Standard *

Whatsapp Mobile Number* OTP and updates will be sent to this mobile

Email Address* All confirmation and updates will be sent to this Email id

School / College Details

Name of School / College *

Board / University *

Complete Address *

Family Details

Total Family Members * Enter the total number including the student.

#	Name	Relation	Profession	Annual Income (₹)
Total Family Annual Income	₹ 0.00

Family Financial Details

Annual School Fees *

Books & Uniform Expenses

Scholarship Received From Other Trusts

Monthly Electricity Bill Amount

Residence Type

Total Annual Family Income

Bank Details

Account Holder Name *

Bank Name *

Account Number *

IFSC Code *

Account Type *

Father's PAN No (Optional)

Mother's PAN No (Optional)

Reference Details

Referred by (Samaj Life member) *

Mobile Number *

Membership No (Optional)

If referred by a GSB Samaj Goregaon member, please provide their name and membership details.

Document Uploads

Mandatory Documents: Upload PDF, JPG, JPEG or PNG files only (Maximum 500 KB each).

Student Photograph *

Latest / Last Year Marksheet *

School ID Card / Fee Receipt *

Student Aadhaar Card *

Income Proof Type *

Upload Income Proof * Accepted documents include Salary Slips, Form 16, Income Tax Return (ITR), Income Certificate, Employer Certificate, Pension Statement, Business Income Proof, Affidavit, BPL Certificate, etc.

Latest Electricity Bill *

Bank Statement / Passbook (Last 6 Months) *

Cancelled Cheque *

Terms & Conditions / Declaration

I understand that submission of this application does not guarantee approval of Educational Assistance.
I declare that all information provided in this application is true and correct to the best of my knowledge.
I understand that if any information or document submitted is found to be false or misleading, the application may be rejected and any assistance granted may be withdrawn.
I confirm that all uploaded documents are genuine and valid.
I authorize GSB Samaj Goregaon to verify the information submitted in this application.
I consent to the collection, storage and processing of my personal information solely for the purpose of Educational Assistance evaluation and administration.
I understand that original documents may be required for verification upon request.
I declare that the total scholarship assistance received from other trusts or organizations does not exceed my actual educational expenses.

Consent

I have read and agree to the terms and conditions^*

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Education Assistance Application Form

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