Backward Classes & Minorities Welfare Dept.

Fresh Application

Madhya PradeshScholarship Portal 2.0

Integrated Scholarship Application form- Post Matric Scholarships for year

2014-15

Applicant Code : 1235413

Application Number : 318404

Scheme : Post Metric Scholarship for OBC

Lock Date: 14/02/2015 IPAddress : 123.63.70.189

Version No: 4
Verification Code: 4760
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sigh in it.
Previous Year Scholarship Details

No Scholarship sanctioned last year

1. Personal Details

SAMAGRA ID : 168489306

Name : MAYANK JOSHI

As per SAMAGRA: Mayank Kumar

Gender :

Male

Religion :

Aadhaar No : 573575430448
As Per Board Marksheet : MAYANK JOSHI

Special Category :

Hindu

Father's Name : MAHESH JOSHI

As Per Board Marksheet : MAHESH JOSHI

Mother's Name : MANISHA

As Per Board Marksheet : MANISHA JOSHI

Date of Birth :

31/03/1997

2.Category OBC

Locomotor Disability

Admission Date :

3.Academic Details

Course :

As Per Board Marksheet : OBC

Caste Certificate : No: 3659 Issued by :Sub Divisional Magistrate Sehore On :04/11/2007

Institute :

As Per Board Marksheet : 31/03/1997

05/08/2014

Enrollment No. :

0183ME141054

Radha Raman Institute of Research, & Technology, Bhopal District: BHOPAL

B E [Full Time]/Mechanical Engineering/1Yr

Hostel Admission Date: Non-Hosteler

10th Board Name: MP Board of Secondary Education, Year: 2011-12, Roll No.: 126430916

4. 10th Board Details

5. Last Year Exam Details :

Exam Name: HIGHER SECONDARY, Exam Date : 01/03/2014

School./Institute :STAR PUBLIC CARRER H S SCHOOL LODHI MOHALLA GANJ SEHORE

6. Total Annual Family Income :

Result : PASS

Rs.36000/-

Income Certificate issued by-TEH SEHORE On : 13/07/2012

7 Contact Details

Mobile No :

Correspondance Address :

9977333410

joshimayank21[AT]gmail[DOT]com

Rathore mohalla ganj sehore, District :- SEHORE

Permanent Address :
Rathore mohalla ganj sehore, District :- SEHORE
8. Bank Account No: 0447001500023745, IFS Code: PUNB0044700, PUNJAB NATIONAL BANK, Sehore, SEHORE

]fDeclaration from Student and his Parent

We, MAYANK JOSHI S/o MAHESH JOSHI and MAHESH JOSHI hereby declare that Board Roll No, Samagra ID, caste certificate and income
certificate, bank account details and all other information given in the application form is complete and correct. We have not submitted any other
application for scholarship for current academic year in any other institution in India. We also undertake that, if any information given above is found to
be false at any stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal action against us.

MAYANK JOSHI S/o MAHESH JOSHI kMAHESH JOSHI `f]_

CB[[]\`\[f@][^
ff]@\`_]f
f[@

(Signature of Parent / Date

(Signature of Student / ]

Delcaration from Institute Head & Institute Scholarship Nodal Officer

We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He has passed last exam and is eligible for
sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him for sanction of scholarship as per the rules. We also
undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter to the
concerned district office so that his scholarship can be put on hold. In case any information of found to be incorrect, Government will be free to
initiate action against the institute.
(Signature of Institute Scholarship Nodal Officer)

Date

(Signature of Institute Director/Prinicpal)

Generated by Scholarship Portal as on 2/14/2015

Fresh Application

Backward Classes & Minorities Welfare Dept.

Madhya PradeshScholarship Portal 2.0

Integrated Scholarship Application form- Post Matric Scholarships for year

2014-15

Applicant Code : 1235413

Application Number : 318404
Version No: 4

Scheme : Post Metric Scholarship for OBC

Verification Code: 4760

Lock Date:

14/02/2015

IPAddress : 123.63.70.189

Your 10th Board Details 10th Board Name: MP

Board of Secondary Education, Year: 2011-12, Roll
No.: 126430916

Caste Certificate Details No: 3659 Issued by :Sub

Divisional Magistrate Sehore On :04/11/2007

ALERT: Details of Applications already registered by using same Samagra ID :

Nil
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil

(Signature of Parent / Date

(Signature of Student / ]

Generated by Scholarship Portal as on 2/14/2015