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PROFORMA FOR DEFENCE PERSONNEL UNDER CLAUSE 6(e) PROFORMA FOR DEFENCE PERSONNEL UNDER CLAUSE 6(f)
OF ITEM 6 OF CHAPTER –1 OF BROCHURE and 6 (o) OF ITEM 6 OF CHAPTER –1 OF BROCHURE
This is to certify that Sri / Kum ………………………………………. This is to certify that Sri / Kum ……………………………………….
DOB……………. Class ………… Name and Place of the School DOB……………. Class ………… Name and Place of the School
………………………………………… is the Son / Daughter of service ………………………………………… is the Son / Daughter of service
No. …………….. Rank …………….. Name …………………………… No. …………….. Rank …………….. Name ……………………………
Trade …………………….………. Who is a combatant member of the Trade ………………………. Who is a combatant member of the
………………………………… wef …………………… and has served ………………………………… wef …………………… and presently
/ presently serving at ……………….. (unit) …………………… (place) serving at ………………….. (unit) …………………… (place) wef….
wef…. …………. to …………..Service No. ………..…………… Rank Service No. ………………. Rank …………….. Name ………………
…………………… Name …………..…… Trade …………………. Unit Trade …………………. Unit …………………. Is a defence personnel
…………………….. Is a defence personnel according to definition as according to definition as laid down by Government of Karnataka. His
laid down by Government of Karnataka. His present residential permanent residential address at the time of joining service as per
address as per his service document is ….. his service documents is……………… ……………………… …
…………………………………………………………………………….. ……..………………………………………………………………………
………………………………………………………………………………
…………………………………………………………………………….. Date: (Signature of parent)
Contact Number:
Date: (Signature of parent)
Contact Number: COUNTERSIGNED BY
Unit Seal
COUNTERSIGNED BY Date: Stamp and signature of the
Unit Seal Commanding Officer
Date: Stamp and signature of the Unit Seal VERIFIED BY
Commanding Officer. Date: Stamp and signature of
Director at Integrated HQ of
MoD / Chief Records Officer

PROFORMA FOR DEFENCE PERSONNEL UNDER CLAUSE 6(g)
OF ITEM 6 OF CHAPTER –1 OF BROCHURE
Income Certificate / ªÀgÀªÀiÁ£À
zsÀÈrÃPÀgÀt ¥ÀvÀæ

This is to certify that Sri / Kum ……………………………………….
DOB……………. Class ………… Name and Place of the School All candidates including General Merit
………………………………………… is the Son / Daughter of service
No. …………….. Rank …………….. Name …………………………… candidates are eligible for Supernumerary
Trade ………………………. Who is a combatant member of the quota seats. The eligibility for
………………………………… wef …………………… who has served
at …………………..(Name & place of the unit at Karnataka for a supernumerary quota seats will be
period of …… (years) …. Months from ………. To …… and is
posted on duty directly to disturbed areas of J & K or North East or in published on the KEA website before the
Field / Active service (as laid down by ………. Letter No. ……… commencement of the document
dated ……… ) at ……………….(Unit)……………….………… Place
wef…. .,……. Service No. ………………. Rank …………….. Name verification process.
……………… Trade …………………. Unit …………………. Is a The candidates who claim seat under
defence personnel according to definition as laid down by
Government of Karnataka. He has been permitted to keep his family “Supernumerary Quota” will have to obtain
at the following address as per his service document. an income certificate from the concerned
……………………………………………………………………………..
……………………………………………………………………………… Tahasildar.
……………………………………………………………………………..
Date: (Signature of Parent)
Provided that candidates belonging to SC,
Contact Number: ST & Category - I should produce an
Income certificate issued by Jurisdictional
COUNTERSIGNED BY Tahasildar as per the format prescribed by
Unit Seal the Government. (This is for the purpose of

Date: Stamp and signature of the processing eligibility of candidates to claim
Commanding Officer. Government of India scholarship).

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