Application Form

Printed on

9/22/2013 2:20:43 PM

Course

Bachelor of Engineering (Computer

Science)

GOI Post Matric Scholarship , 2013-2014

Application Number

APPk1459223M20092013

Appilcation type

Renewal

Scheduled Caste

Renewal Course Year

Please Paste
Passport Size
Photograph

2011

Student SSC Details

SSC Board

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION

Passing Year

2009

SSC Seat No

k145922

SSC Marks Obtained

74.15

Applicant's Details
Applicant Name PRIYA
Date of Birth

29-11-1993

Application Date 12-09-2013

Caste

Mother's Name

KASHINATHRA WANARE
O
Gender
Female

Is Resident of Maharashtra Maharashtra

Maritial Status

Caste Category

No

Chambhar (11)

Orphan

MANGAL

Scheduled Caste

Sub Caste

No

Is Disabled

No

Disability Type

Is Applicant Salaried ? NO

Applicant's
Annual Income

0.00

Total Annual Income 40000.00

Is Staying at Hostel ?

Has Applied For Hostel ?

No

N.A.

No

Student Prequalifying Details

Academic Year

Institute

Course

Course Year

Percentage

Result

2012 - 13

M.G.M's College of
Engineering, Nanded-431605

Bachelor of Engineering
(Computer Science)

63.04

Pass

2011 - 12

M.G.M's College of
Engineering, Nanded-431605

Bachelor of Engineering
(Computer Science)

61.92

Pass

2010 - 11

TOSHNIWAL ARTS
,COMM,SCIENCE COLEGE
SENGAON DIST HINGOLI

12 th (Science)

61.00

Pass

Institution Details
Name of School/College/Institute
where Admitted

M.G.M's College of Engineering, Nanded-431605

Course Name

Bachelor of Engineering (Computer Science)

Course Year

EID Number

1327/13033/31855 16/09/2013 18:01:04

CAP Number

N.A

UID Number

OS,DBMS,TOC,C
N,COA
College Adm.No 648

Academic Year

2013-2014

Is Admission after
Diploma

Admission Dt.

06-09-2013

Joining Date

Is Fees Paid ?

No

Fee Paid

0.00

N.A

GrantType

Non Granted

Fee Receipt
No.
Quota
Government Quota

Subject

Fee Receipt
Date
Contact Details

No

06-09-2013

Residential Number: , MobileNumber: 8698697286, EmailAddress:

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Address For Correspondence

Address:- Location:- City:- Nanded Pincode:- 431605 Taluka:- Nanded District:- Nanded
Parent / Guardian Details
Parent's name

KASHINAT
HRAO
Relation with Applicant Father

Sampati

WANARE

Age

41(yrs)

Profession

Farmer

Parmanent Address

Location:- City:- Nanded Pincode:- 431605 Taluka:- Nanded District:- Nanded

Is Father Alive

Yes

Annual Income 40000.00

Hostel Information
Name of Landlord /
Hostel

Hostel Admission
Date

Hostel Type

Is Mess Service Available?

Hostel/ Landlord
Address

No

Rent Per Month

0.00

Hostel/Landlord
Contact Details

Is Studying in night school

No

Document Details
Caste Certificate No

8301/2743

District Issuing Hingoli

Office

Taluka Issuing
Office

Sengaon

Caste Validity
Certificate No

4331

District Issuing Latur

Office

Scrutiny
Committee No

Issued in

University
Registration No

FE/2011/126/366

Income Certificate
16637
No
Student Bank Account Details
Bank Name

STATE BANK OF HYDERABAD

Branch Name

SENGAON

IFSC Code

SBHY0020691

2013

Bank
Account No

62184132026

MICR Code

560004158

Document Attached
Caste Certificate Issued by Competant Officer
Income Proof Income Certificate Issued by Competant Authority
Marksheets
I-card Size Photo
SSC Mark Sheet
Declaration
The information furnished by me is complete and correct. I bear the complete responsibility for all the above
information.
Applicant's Signature

_______________________

Principal's Signature

_______________________

Applicant Parent's Signature

_______________________

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