Professional Documents
Culture Documents
Government of West Bengal: % of Disability (As Per Certificate) Aadhaar Card No (If Yes)
Government of West Bengal: % of Disability (As Per Certificate) Aadhaar Card No (If Yes)
Child Development Dept. & Women Development and Social Welfare Dept.
[To be filled up in English Block letters only]
KANYASHREE PRAKALPA-Renewal [K1] FORM - NORMAL
Applicant ID : 19080314104180000012
Name : MONIFA KHATUN
D.O.B : 22-12-2004
Institute Name : BRAHMANKHANDA BASAPARA HIGH SC
Mobile No * +91
❏ I declare that I am the applicant mentioned in this application.The following documents are submitted with this application (Tick
applicable)
Certificate of Eligiblity
❏ Applicants staying at Home under JJ Act are excempted from producing the following documents.
❏ Copy of Birth Certificate attested by applicant. I understand that my daughted/ward will not be eligible to apply for renewal of
Kanyashree Annual Scholarship/Upgrade to Kanyshree One time grant next year unless I can provide her birth certificate issued by
the appropriate panchayat/municipal authority.
❏ Declaration by applicant that both parents of the applicant are deceased certified by Competent Authority.
❏ Copy of Death Certificates of mother and father (if both parents are deceased) attested by applicant.
(If AADHAAR card has been provided) I, the applicant given consent do not given consent to the use of my AADHAAR number for
authenticating my identity for Kanyashree Prakalpa.
❏ I declare that I am the father / mother / legal guardian of the applicant, and that her declaration and the documents provided
are true.
❏ I, hereby certify that the applicant mentioned in this application is presently residing in this institution (J.J. Home) and is
unmarried.
Date:____/____/________ ___________________________________
Signature of Superintendent of J.J. Home with Office Seal
❏ I certify that the applicant mentioned in this application is enrolled and regularly attending this institution. I also certify that I
have verified the information given in this application with the documents submitted and certify that she is eligible for the One-Time
Grant.
Date:____/____/________ ___________________________________
Signature of Head of Institution with Office Seal
Administrative Use
Data entered into portal by ___________________________________ on ____/____/________
Data verified by ___________________________________ on ____/____/________
Application sanctioned by ___________________________________ on ____/____/________
.................................................................................................................................................................................................................
Acknowledgement Received
MONIFA KHATUN (19080314104180000012) daughter / ward of residing at have applied for Up-Gradation of Kanyashree
Prakalpa for the year 2018-2019.