VASAVI UNION CHARITABLE TRUST

‘Seva Jyothi’ No.3, Vasavi Vidya Nikethan Complex, Vanivilas Road, V.V. Puram, Bangalore – 560 004.

PHOTO

APPLICANT DETAILS

CANDIDATE NAME :

EMAIL :

DATE OF BIRTH :

ADDRESS :

TELEPHONE :

HIGHEST EXAMINATION PASSED :

NAME OF THE INSTITUTE/COLLEGE :

NAME OF UNIVERSITY/TECHNICAL BOARD :

REGISTRATION NUMBER :

YEAR AND MONTH OF PASSING :

PASSED IN FIRST ATTEMPT? :YESNO

DISTINCTION/RANK ETC :

DATE :

Name of the Candidate :

Examination Passed :

Application received after the last day will not be considered for awards.
Xerox copies of Marks Cards, Degree Certificates, Rank Certificates, etc., are to be enclosed along with the application, duly certified by a Gazetted Officer/Head of the Institution/Bank Manager/ Trustee of the Vasavi Union Charitable Trust.
2 Nos Passport Size Photographs (One to be pasted, another to be enclosed).
Address proof is to be produced to confirm that the applicant is a resident of Karnataka in case the degrees are obtained from a university outside Karnataka.
Students are informed that they have to apply for the award of medals in the calendar year in which the result has been declared. (1st January to 31st December)
Eligibility Criteria:
- Post Graduates, MBBS: 60% of marks
- Graduates other than MBBS: Aggregate 70% of marks
- ICAI, ICWAI, ICS, KPSC & UPSC in Group A/B Passed with good marks/ratings
- Ph.D - any University in India
Special prize: First attempt in all examinations and scored distinction in aggregate

Date Received

Sl No As Per Merit List

Signature of Chairman

Signature of Convenor