| 1 |
Name
of the Student |
................................................ |
| 2 |
Mailing
address |
................................................ |
| 3 |
Permanent
address in Pakistan |
................................................ |
| 4 |
Name
and address of the financier / guardian in Pakistan |
................................................ |
| 5 |
Name
and address of the bank in Pakistan through
Which exchange facility for studies availed. |
................................................ |
| 6 |
Particulars
of last exchange permit |
Permit
No. Date Amount |
| 7 |
Name
of college / university where currently enrolled |
............................................... |
| 8 |
Date
of first enrollment |
............................................... |
| 9 |
Level
and field of study |
............................................... |
| 10 |
Year
of completion of present course |
............................................... |
| 11 |
Income
from Scholarship / Fellowship / Assistantship
/Financial Aid, if any. |
................................................ |
| 12 |
Period
for which exchange facility desired |
................................................ |
| 13 |
Break-up
of exchange requirement for one year |
................................................ |
| (a) |
Tuition
Fees |
$.............................................. |
| (b) |
Compulsory
/ Mandatory Fees |
$.............................................. |
| (c) |
Books
Allowance |
$.............................................. |
| (d) |
Maintenance
Allowance |
$.............................................. |
|
Sub
- Total: |
$.............................................. |
|
Less |
$.............................................. |
| (a) |
Scholarship
etc |
$.............................................. |
| (b) |
Earnings |
$.............................................. |
| (c) |
Provisional
Permit |
$.............................................. |
|
Amount
required |
$.............................................. |