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    Print - Application PDF

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    Ramesh Babu
    This document is an application by Arun Kumar Y for a scholarship from the Government of Karnataka. It contains details about Arun such as his name, address, family details, educational details including the name of his college and course, income details, bank account information, and certificates. It also includes sections for verification by the college principal and verification officer who check the application details and recommend sanctioning of the scholarship.

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    Print - Application PDF

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    Ramesh Babu
    94 views2 pages
    This document is an application by Arun Kumar Y for a scholarship from the Government of Karnataka. It contains details about Arun such as his name, address, family details, educational details including the name of his college and course, income details, bank account information, and certificates. It also includes sections for verification by the college principal and verification officer who check the application details and recommend sanctioning of the scholarship.

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    Print - Application.pdf

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    This document is an application by Arun Kumar Y for a scholarship from the Government of Karnataka. It contains details about Arun such as his name, address, family details, educational details including the name of his college and course, income details, bank account information, and certificates. It also includes sections for verification by the college principal and verification officer who check the application details and recommend sanctioning of the scholarship.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    94 views2 pages

    Print - Application PDF

    Uploaded by

    Ramesh Babu
    This document is an application by Arun Kumar Y for a scholarship from the Government of Karnataka. It contains details about Arun such as his name, address, family details, educational details including the name of his college and course, income details, bank account information, and certificates. It also includes sections for verification by the college principal and verification officer who check the application details and recommend sanctioning of the scholarship.

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    10/26/2018 Print - Application

    Government of Karnataka

    Department of Backward Classes Welfare


    Student Application cum Verification Report for
    Post-Matric/Food & Accomodation/Fee Concession (OR) Nursing
    Renewal 2018-19

    1. Application No: 2018 0100 9701 2. Application Date: 12-10-2018 3. Caste Category / Caste: CAT-I / Uppara(Sl.No-53-(a))

    4. Student Name : ARUN KUMAR Y 5. Gender : Male

    6(a). Father Name : RANGAIAH Y 6(b). Mother Name : PUSHPALATHA Y

    7. Address & Mobile No : ASHOK NAGAR ,Bbmp , Ward No.56 ,BANGALORE URBAN & 90XXXXXX62

    9. Pass Year: 2014-Karnataka SSLC


    8. SSLC HT No : 20XXXXXXX07 10. Date of Birth: 22-10-1998
    Board
    11.Family Annual Income (in Rs.): 18000 12. SATS ID : -NA- 12(a). Ration Card : -NA-

    13.College Details(college Nature) : BMS COLLEGE OF ENGINEERING , Bbmp,Bangalore Urban , (Private Aided College) ,Visvesvaraya
    Technological University (VTU), Belgaum
    14. Course Name /Course Year /Duration of Course : BE (ECE) / III Yr / 4 Yrs

    15. College Admission No / Admission Date(of this year): 20274179586 / 13-08-2018 16. Distance (in Kms.) : 2
    18. Scholarship Applied for: 1.Post-Matric/Food &
    17. Scholarship Type : Day Scholar
    Accomodation,2.Fee Concession
    19. Bank Name / IFSC Code: ALLAHABAD BANK /ALLA0212011 20(a). Bank A/c No : XXXXXXX1829
    (a).Income Caste Cert. No. : (b).Cat-1 Caste Cert. No.: (c).Aadhaar No. / Name: XXXXXXXX0580 / Y ARUN
    RD003818XXXXXX0 RD003818XXXXXX9 KUMAR
    .

    I. Declaration and Aadhaar Consent


    I hereby consent for the use of my Aadhaar number of XXXX / XXXX / 0580 , provided in the application for Scholarship, to carryout Identity
    Validation,to make Direct Benefit Transfer of Scholarship to the Bank Account and also to seed the said Aadhaar number into ePASS Scholarship.
    Further, I also consent to obtain its Aadhaar Number and to use the Aadhaar number, so obtained, to carryout Identity validation and also to make
    Direct Benefit Transfer of Scholarship to the Bank Account."
    I hereby certify that that above information furnished is true. I have not availed any other scholarship for this purpose from any other sources. I
    shall abide by the terms and conditions of the sanction of the scholarship. If any discrepancies are found later, I hereby abide for refund of the
    scholarship amounts claimedand also am liable for action by the Department .

    Signature of the Student


    Date :

    II.Verification Report of College Principal


    This is to certify that the information furnished above is verified with the records and found to be correct. He / She is a bonafide student of our
    college studying in BE (ECE) / III Yr (Course & Course Year) during 2018-19 .

    Signature of the Principal


    Date :
    (With College Seal)

    III.Verification Report of Verification Officer/


    I have verified the contents of scholarship Renewal application with reference to the college records and original certificates, physically
    identified the student verified the following certificates

    Yes No Yes No Yes No Yes No Yes No


    Caste : Income: SSLC: TC: Ration Card:

    SATS Yes No Yes No Bank Yes No Yes No Previous Yes No


    Aadhaar: PHC:
    ID: Passbook: Marks:
    Other Details/Certificates if any:
    I recommend for sanction of :
    Post-Matric/Food & Accomodation/Fee Concession (OR) Nursing

    I do not recommend the sanction of scholarship for the following reasons. (Please specify)

    I have physically verified the SSLC Certificate in person

    file:///C:/Users/Arun%20kumar/Downloads/Print%20-%20Application.html 1/2
    10/26/2018 Print - Application

    Date : Signature of the Verification Officer

    October 26, 2018 09:27:03 AMOctober 12, 2018 08:17:27 PM

    file:///C:/Users/Arun%20kumar/Downloads/Print%20-%20Application.html 2/2

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