APPLICATION FORM FOR BOOK GRANT - FIITJEE

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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