HEC Needs Based Scholarship Program2016-17
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Higher Education Commission

Name of the University: _____________________________________________________________

Degree Title / Program: _____________________________________________________________ 1. Applicant’s Name: ____________________________________Gender: Male           Female

2. Applicant NADRA NIC No.
3. Marital Status	Single

Married	Divorced

4. Age : _________	Domicile _______________________________________________

5. Present Address	_________________________________________________________ 6. Permanent Address:	______________________________________________________ 7. Are you currently working: Yes	No

8. If answer is Yes to Section No. 8 complete the sections (9-13)

Designation: ___________________ Name of Employer /Company: _________________ 9. Total Monthly Applicant Gross Income in Pak Rs. ________________________________ 10. Total Monthly Applicant Take Home Income* in Pak Rs. __________________________
* Take Home Income: Salary / Pay available after deduction of taxes, provident fund charges etc.

S	Family

#	Member Name

Family Member

Relationship	occupation

(Specify)

Organization

Name

Monthly

Pay/Earning

Designation	Gross	Remarks

1

2

3

4

14 Total Monthly Family Income (add Self Income, if applicable) Pak Rupees

-	-

11. Tel (Res.): ______________Mobile: ______________ Email: ________________________ 12. Total Family Members currently living with you: ___________________________________
S #	Name of Family Member (s)	Relationship	Marital Status	Remarks** 1
2 3 4 5 6
13. Details of Family Members Earning (Take extra sheet if required):

HEC Needs Based Scholarship Program2016-17
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Higher Education Commission

15. Brothers/Sisters/Children/Family Members studying _____________________________

Relation
S #	Name	 with	Name &Address of Institute	Fee per month applicant
1

2

3

4

5

6

15A Total Fees & Tuition Charges

16. Father’s Name: _________________ Computerized N.I.C. No ________________________

17. Status: Alive	Deceased

18. Professional status: Employed	Retired	Business Owner

19. Name of Company/Employer:__________________________________________________ 20. Tel (Off): ______________________________ Mobile: ______________________________ 21. Occupation Type: ______________________ NTN_________________________________ 22. Designation & Grade ( BPS/ SPS/PTC etc): ________ Gross Monthly Income: ____________ 23. Total Net Monthly Take Home Income (Salary/ Pension/ Others): _______________________ 24.Any Other Supporting Person (Mother/ Guardian/ Brother/ Sister/Family Relative/Guardian): 25. Name: ___________________________	Relationship: _________________________ 26. Occupation and Designation ____________________________________________________ 27. Monthly Financial Support Available to Applicant in Pak Rs. ___________________________
28. Asset Income (on monthly basis)
S #	Income Source	Father	Mother	Spouse	Self	Other	Total

1	Property Rent

2	Land Lease

3	Bank Deposits*

4	Shares / Securities*

5	Other (Specify)

28A Total

HEC Needs Based Scholarship Program2016-17
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Higher Education Commission

29. Total Family Monthly Income

S #	Family Member Name

Monthly Income

Relationship	from Assets

Monthly Gross

Pay/Earning

Monthly Net

(Take home)

Pay/Earning

1

2

3

4

5	Applicant Monthly Gross Pay/Earning

6	Applicant Monthly Net (Take home) Pay

29-A	Total Monthly Income in Pak Rupees

Total Annual Income in Pak Rupees 29-B

30.FAMILY EXPENDITURES

30A. Accommodation Expenditures

Type: Bungalow	Apartment /Flat	Town House	Village House

Status: Rented

Self or Family owned

Employer / Govt Owned

Rent Payment: Self

Employer/Govt

Others

House Plot Size in Sq. ft._________________ Covered Area in Sq. ft._________________

S #

Accommodation

Location /Address

Number Of

Bed Rooms

Number Of

Accommodation

Monthly Rent

Accommodation

Annual Rent

1-2

2-4

4-6

Above 6

Air conditioners 1-2
2-4

4-6

Above 6

30B Total Accommodation Rental Expenditure

Any other house/flat owned by the Parents/Guardian (if yes please specify with location and size)_______________________________________________________________

HEC Needs Based Scholarship Program2016-17
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Higher Education Commission

31. Utilities Expenditures

Last Month Utilities Paid

Telephone	Electricity	Gas	Water

32. Medical Expenditures: Average of last six months (Per Month Expenditure)___________

Total Family Expenditures

Education

S #	Expenditure

Accommodation

Expenditure

Utilities

Expenditure

Medical

Expenditure

Misc.

Expenditure

Total Monthly

Expenditure

Total Annual

Expenditure

33

S #

Description

Amounts in Pak Rupees

(Sec.29A)

Total Monthly Income

(Sec. 33)

Total Monthly Expenditure

34 (29.A – 33A)

Net Monthly Disposable Income*

S #

Description

Amounts in Pak Rupees

(Sec.29B)

Total Annual Income

(Sec. 33)

Total Annual Expenditure

35

(29.B – 33.B)

Net Annual Disposable Income*

* If the monthly / Annual Disposable Income is negative, kindly explain the reasons for the gap, and the arrangements through which the differential gap is met by the family

Assets (with current market value)

36. Does the family own any Transport? Yes	No If yes kindly fill the relevant details

S #	Transport Type

Make

/Model

Engine Capacity (CC)	Registration No.

Ownership

Period

(Car/ Motor cycle/ Others*) 1
2

* Others: include tractor, rickshaw, bi-cycle, motorcycle rickshaw, carriage pick, truck etc.

HEC Needs Based Scholarship Program2016-17
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Higher Education Commission

37. Number of Cattle(s) (with kind) ____________________________________________

38. Area and location of Land(s)/Plot(s) owned _______________________________________

Assets Title

Cultivable Qty	Size	Location (Address)	Area

Agricultural Yield per Acre

Residential

Commercial

Agricultural Employer/Govt Scheme

39. Assets worth (Current Market Value in Pak. Rs.)

S #	Assets Title	Father	Mother	Spouse	Self	Guardian	Total 1       House

2	Business

3	Land & Building

4	Bank Balance

5	Stocks/Prize bond

6	Others/ Cattle(s)

40.	Total

41. Loan taken for Applicant Education * Family/ Friend Loan
(Specify details of loan taken and relationship with the relative / friend) __________________________________________________________________________________

_________________________________________________________________________________

42. Any source of financing other than loan (Please specify)__________	____________ __________________________________________________________________________________

__________________________________________________________________________________ 43. How were the admission /first semester charges paid?

__________________________________________________________________________________

__________________________________________________________________________________

44. Applicants educational record:

Level of Study

Name and Location of Institute

Per Month Fee

To- From month/ yr.

Division/     %age / GPA/        CGPA

Bachelors

Intermediate

Secondary

HEC Needs Based Scholarship Program2016-17
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Higher Education Commission

45. Per month fee/ tuition charges of the institution last attended ______________________

46. Have you ever got any other Scholarships: Yes ______ No __________

(If yes fill the details of scholarships & attach documentary proof of the scholarships)

S #	Name of Institute

Scholarship Name

Total Scholarship Amount

Total Scholarship Period

Class / Level at which Scholarship was granted

1

2

Statement of Purpose (Explain your suitability for this scholarship) - attach separate sheet if required

__________________________________________________________________________________ _________________________________________________________________________________ UNDERTAKING
1.	The information given in this application are true to the best of my knowledge and I understand that any incorrect information will result in the cancellation of this application. If any information given in this application is found incorrect or false after grant of financial assistance, the institute will stop further assistance and the student will have to refund all payment received and or penalty equal to total scholarship amount.
2.	HEC reserves the right to use information given in this form for verification and other purposes.

Date: Parents / Guardian Signature ___________________	Applicant Signature: ______________________________

For Official use only
Are the applicant documents in order?	Yes	No

Application Case Review Dates (i) _________________(ii) _________________________________

Additional Remarks

______________ Date

_______________ Department Name

___________________________________ Signature Head of Department / Focal Person