IIT where currently studying_______________________Entry No. ... I have
purchased the following books for the semester for which necessary receipts are
...
APPLICATION FORM FOR BOOK GRANT Name of the Student :___________________________________________________________________________
FIITJEE Enrolment No. ____________________Batch No. ______________Year of studying _________________ AIR No._______________in IIT-JEE held in ________________________. IIT where currently studying_______________________Entry No.________________Branch__________________ Semester for which Book Grant is claimed _____________________Amount_______________________________ I have purchased the following books for the semester for which necessary receipts are enclosed and I am submitting this application form duly certified by the professors. Sl. No.
Name of the Book
Price
Name of the Teacher/Professor
Certified that the Books are prescribed by me (Signature of the Teacher/Professor)
Mathematics 1 2 3 4 Physics 1 2 3 4 Chemistry 1 2 3 4 Total :-
Dated :______________
STAMP OF IIT
Permanent Residential Address (in Capital letters) : -
Signature of the Student Name :- _________________________
________________________________________
Address
________________________________________
________________________________
( in Capital Letters) : -
________________________________________
________________________________
E-mail ID:________________________________
________________________________
Phone & Fax (with STD code)________________
________________________________
In case of change in information, please inform us or email at
[email protected] In case cheque is to be sent at location other than Permanent Residential Address ----------------------------------------------------------------------------------------------------------------------------------------------------------FOR OFFICE USE Passed for payment of Rs.________________ (Rupees_____________________________________________)
(Authorised Signatory)
Paid vide Cheque No._____________dated __________for Rs.____________drawn on Canara Bank, Hauz Khas Market Branch, New Delhi-110016.
(Sr. Accountant) (Dy. Manager - Accounts) ____________________________________________________________________________________________
ICES House, Sarvapriya Vihar (Near Hauz Khas Term.), New Delhi-16, Ph:26515949, 26569493, Fax: 26513942