KBCT : Application

To download application form please click here.

To download medical help form please click here.

KHIMJI BHAGWANDAS CHARITY TRUST

Lohana Bhuvan, Paliram Road, Behind Municipal Office,
Andheri (West), Mumbai - 400 058. Tel. C/o. 2628 3715.
Office Address : Raghuvanshi Mansion, Block No. 20, Raghuvanshi Mills Compound,
11/12, Senapati Bapat Marg, Lower Parel (west), Mumbai - 400 018. Tel. : 2498 2664
E - Mail : trustees@khimjibhagwandascharitytrust.org Website : www.khimjibhagwandascharitytrust.org

All details marked below must be clearly state by the applicant end no column must be left blank.

Full Name (Surname First)	:
Present Address For Correspondence	:
Telephone No.	:
Permanent Address	:
Age	:
Date of Birth	:
Marital Status	:

Details of school Carrier (Full details expected - lf necessary give details on separate sheet)

Name of School	University / Board	Last Exam Passed	Year	UNIVERSITY / BOARD
Name of School	University / Board	Last Exam Passed	Year	Class	Name	Percentage

Details of University Career

Name of College	University	Degree / Diploma Exam Passed	SUB	YEAR	UNIVERSITY / BOARD
Name of College	University	Degree / Diploma Exam Passed	SUB	YEAR	Class	Name	Percentage

Any Special Distinction / Scholarship Obtained	:
Post Graduate & Research Work (lf Any)	:
Experience / Practical Training (lf Any)	:
Employer's Name (lf Any)	:
Telephone No.	:
Present Salary(In Rs.)	:	Per Month.

PROPOSED COURSE OF STUDY	YEARS REQUIRED	COST P. A.
PROPOSED COURSE OF STUDY	YEARS REQUIRED	TUTION	BOARDING & LODGING

Admission Has Been	{	Secured at
	{
	{	Sought at
	{

Total Amount of Scholarship required from KHIMJI BHAGWANDAS CHARITY TRUST

Rs.

Amount Desired to this Term /Year :

lf You have applied for Assistance / Scholarship to any other Trust / lnstitute :

NAME OF THE TRUST & ADDRESS	AMOUNT REQUESTED	AMOUNT SANCTIONED

Details regarding person who will guarantee payment & repayment of the Scholarship

Name & Full Address	Occupation	lncome Per Month Rs.	Relation to Applicant	Telephone No

Name & Address of 3 reference under whom the applicant has studied or worked or is personally Known

Name & Full Address

Family lnformation (Please Fill All the Columns)

Family Members	Name	Age	Education	Employment / Occupation	Gross Annual lncome
Father
Mother
Other Earning Member
Other Earning Member
Other Earning Member

Employer's Name & Address ln Full (of Father or any Earning Member) :

Occupation	:
Salary Rs.	:	Per Month.

+ Applicaiton Form For Medical Help

KHIMJI BHAGWANDAS CHARITY TRUST

Lohana Bhuvan, Paliram Road, Behind Municipal Office,
Andheri (West), Mumbai - 400 058. Tel. C/o. 2628 3715.
Office Address : Raghuvanshi Mansion, Block No. 20, Raghuvanshi Mills Compound,
11/12, Senapati Bapat Marg, Lower Parel (west), Mumbai - 400 013. Tel. : 2498 2664
E - Mail : trustees@khimjibhagwandascharitytrust.org Website : www.khimjibhagwandascharitytrust.org

All details marked below must be clearly state by the applicant end no column must be left blank.

Name of the patient	:
Age	:
Address of the patient	:
Type of Illness	:
Name and Address of the doctor for the first treatment	:
Address of the patient residing near the hospital	:
Approximate Medical expenses to be incurred	:
Name and Address of the hospital where patient is admitted	:
Mode of Payment for hospital expenses	:
Receipt number of Hospital Bill	:
Information on Financial and relatives of the Patient
No of person in patients family	:
Nature of Business of the patient	:
Annual Income of the patient and his family	:
Any help received from the other trust	:
Name and Address of the person introduced to this trust	: