Registration no. (To be filled by the Office) For the Year INTERNATIONAL CHILDREN’S EXCELLENCE FUND New Delhi - 110026 Website : www.incef.org.in APPLICATION FOR REGISTRATION FOR INCEF’S ALL INDIA MERIT SCHOLARSHIP EXAM. - 2015 (To be filled by the Parent/Guardian) 1. Name of the Student (In capital Letters) Affix a Photograph of the Student 2. Sex (Male/Female) 3. Father’s Name (In capital Letters) 4. Mother’s Name (In capital Letters) Affix a Photograph of Parent/Guardian Form will not be accepted without photograph Date Month Year 5. Date of Birth 6. Present Address ................................................................................................................................................................................. District . ............................................................... State............................................................... Pin code Phone No. with STD Code (Land Line).............................................................. Mobile No. ................................................ E-mail ..................................................................................................................................................................................................... 7. Class in which studying at present.............................................................................................................................................. 8. Name of the School (Where studying)...................................................................................................................................... Address of the School ...................................................................................................................................................................... District.............................................................. State . .................................................................Pin code 9. i. Payment of Registration Fee : Amount of Rs. 1,000/- (Rupees One Thousand only) for Registering the name of the boy / girl for the said Merit Scholarship Test is being sent with this form by A/c payee Bank Draft / At-par cheque in favour of “INTERNATIONAL CHILDREN’S EXCELLENCE FUND” payable at New Delhi. ii. Name of the issuing Bank ..................................................................................................................................................... iii. Bank Draft (At-par cheque No. ......................................................................................Dated ........................................ iv. Issued from (Place of the Bank’s branch)........................................................................................................................ Note : 1. Please send a self – addressed stamped (Rs. 40.00) Envelope of 4” x 9” size with this Form if parents wish to receive admit card by registered post, otherwise Admit Card will be sent by ordinary Post or by E-mail 2. Please see overleaf- 10. Choice of profession or career desired by the parents for their wards for future study: Tick () for choice Profession / Career (Please Tick for specific profession) as desired First Second Third (i). Executive and Administrative Services (for the Government Corporate, Public, Private Sector establishments etc.) (ii). Medical Sciences (iii). Dental / Para-Medical Sciences /Medical-Electronic /Hospital Management (iv). Micro Biology / Genetics (v). Engineering and Technology (Mechanical, Electrical, Civil, Chemical, Marine, Aeronautical, Automobile) (vi). Electronics (General / Micro-Electronics) (vii). Computronics (Software / Hardware) (viii). Information and Communication Technology (ix). Industrial Organization and Administration (x). Industrial & Business Management (xi). Financial Management (xii). Merchant Navy (xiii). Printing Technology (xiv). Tourism (xv). Teaching (xvi). Fashion Technology (xvii). Textiles (xviii). Law (xix). Chartered Accountant (xx). Any other Profession ………………….. 11. Choice of place of study for class I to XII (i.e. for School Education) (i). Dehradoon (ii). Ranchi (v). Rishipattanam (Ranchi) (vi). Ramgarh Cantt. (Distt. Ramgarh), Jharkhand Tick () for choice DECLARATION I hereby declare that all information given above are true to the best of my knowledge. I have gone through the rules and regulations of the Scholarship and agree to be bound by them. I undertake to accept the decision of the INCEF as final and binding upon me on behalf of my ward. The choice of profession / career given above for my ward may be changed as per potential and attitude of the child found in course of study or as suggested and recommended by the experts. ............................. Date ............................. ............................................................... Place Signature of the Parents / Guardian FOR OFFICE USE REMARKS OF THE EXPERTS / EXAMINERS ............................. Date ............................................................... Signature of the counselor/Expert