APPLICATION FORM FOR OBTAINING SCHOLARSHIP FROM S.VAIDYANATH AIYAR
                       MEMORIAL FUND - 2014

The Member Secretary
S.Vaidyanath Aiyar Memorial Fund
The Institute of Chartered Accountants of India
ICAI Bhawan, I P Marg
New Delhi ­ 110 002.

Dear Sir,

I request that I may be provided scholarship from S.Vaidyanath Aiyar Memorial Fund for
pursuing the Chartered Accountancy course. I give below my particulars as:






        i) Name of the applicant
  1
        ii) Date of Birth

        iii) Age


        Articles Assistant Registration No.
  2

  3
        Full Address


        Marital Status
  4
        i) Father's Name
5 (a)
        ii) Occupation
        iii) Address
        iv) Monthly Income (Attach
            documentary proof)

        i) Mother's Name
5 (b)
        ii) Occupation
        iii) Address
        Monthly Income (Attach
        documentary proof)

  6     Details of total income from all sources per
        month Indicate separately from each
        source.
        Total monthly expenditure of the Students.
  7
        What is the source from which the applicant
  8     is presently meeting his/her education
        expenditure per month?
        Detail of the parents /brothers /sisters of the
  9     articled assistant and their occupation and
        their income together with source. The
        details of the financials assistance, if any,
        provided by them to the students.


                                                                                    1
                                                        Marks secured in percentage and
         Qualifications of the articled assistant       whether first attempt or not [state the
 10
         [enclosed copies of mark sheets of             attempt]
         examinations passed]                           Marks             Attempt

          i. 12th                                       a)................%    ..................
         ii. CPT                                        b)...............%    ..................
         iii. Intermediate / PE-II/PCE/IPCC             c)...............%    ..................
         iv. Graduation/Post Graduation                 d)...............%    ..................



         Whether Physically Challenged (if yes,
 11.
         enclose attested copy of medical
         certificate).


12. Particulars of the family members of the applicant including parents, sisters and brothers.

 S.No     Name                                Age    Relationship       Occupation        Annual
                                                                                          Income
 (i)
 (ii)
 (iii)
 (iv)
 (vi)

13 Particulars of School/College/University etc. where the student had studied (Any break in
   the education career should be indicated in the remarks column and attested copies of
   the certificate should be sent with this form)

              Name                   of Examination        Marks       Division             Remarks
 S.No         School/College            Passed             Obtain      awarded and
              and Institution                              s           % of marks
 (i)
 (ii)
 (iii)
 (iv)
 (v)

14 Whether any assistance received / likely to be received from Chartered Accountants
Students Benevolent Fund or from any other source, and if so, provide details.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
15 The extent of scholarship sought from the S.Vaidyanath Aiyar Memorial Fund
   and state reasons for the same
._________________________________________________________________________
_________________________________________________________________________








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16 Name, membership no. and address of Principal under whom practical training is being
received
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

I hereby declare that the particulars given above are true and complete to the best of my
knowledge and belief and I have not concealed any information there from. I am aware that
in the event of any information, if found to be false, distorted or twisted later, I will be
disqualified from the receipt of any scholarship from S.Vaidyanath Aiyar Memorial Fund and
would be bound to refund the amount even if received already to S.Vaidyanath Aiyar
Memorial Fund.
                                                                    Yours faithfully


                                                                                                                       Signature:


                                                                                    Name___________________________

                                                                Articled Registration No. ______________________

                                                                                              Correspondence Address:


Place:_______________


Date:________________



                                                                                   Mob.No.


                                                                                   E.Mail.id:




                                                         REMARKS OF THE EMPLOYER

................................................................................................................................... ................

.........................................................................................................................

............................................................................................................................. ......................


   Address___________________                                                     Signature___________________
   Telephone No. ____________                                                      Name__________________
  email id______ ________                                                         Membership No._________



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                              RECOMMENDATION


*Recommendation of the Central Council Member/Chairman/Vice-Chairman/Secretary of the
Regional Council or Branch of the Regional Council/Ex-President of ICAI/Chairman/Vice-
Chairman, Member Secretary and Managing Committee Members of the S.Vaidyanath
Aiyar Memorial Fund.

"I have gone through the particulars in the application form which has been filled in
completely and the particulars stated therein are prima facie correct. In my opinion, it is a
deserving case for scholarship from S.Vaidyanath Aiyar Memorial Fund may be sanction as
per the guidelines. .

Telephone No.___________                                     Signature__________________

Mobile No. ______________                                    Name ____________________

Email id.________________                                       Membership No. __________

Place: __________________                                       Address/Rubber Stamp______

Date: _________________                                         _________________________

*Strike out which not applicable.



Articled Registration No.                          Articled Registration No.

Name                                               Name

Correspondence Address:                            Correspondence Address:




Mob.No.                                            Mob.No.


E.Mail.id:                                         E.Mail.id:

Note:
   1. Kindly sent the application on above address of ICAI duly filled in and duly
      recommended by your principal and Central Council Member/Chairman/Vice-
      Chairman/Secretary of the Regional Council or Branch of the Regional
      Council/Ex-President of ICAI/Chairman/Vice-Chairman, Member Secretary and
      Managing Committee Members of the S.Vaidyanath Aiyar Memorial Fund along
      with necessary documents.

   2. Those students who are receiving or likely to be receiving financial assistance
      from Chartered Accountants Students Benevolent Fund/ Scholarship from
      Board of Studies of ICAI/ any other sources for above period need not apply
      for the same.




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