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    BIKASH

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    bikashsukamajhib
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    © All Rights Reserved
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    BIKASH

    Uploaded by

    bikashsukamajhib
    1 views3 pages
    Thank you help me

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    © © All Rights Reserved

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    Copyright:

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    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1 views3 pages

    BIKASH

    Uploaded by

    bikashsukamajhib
    Thank you help me

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    ଓଡ଼ିଆ A- A A+  Screen Reader

    Scholarship Application Form


    ST&SC and MBC Welfare Department
    Academic Year 2024-25 STSC92411126473449
    Government of Odisha

    Basic Information

    Department Scheme Academic Year Application Type


    ST&SC and MBC Welfare Post Matric Scholarship 2024-25 Renew in New Course
    Department

    Applicant Details

    Applicant Name Category Whether belong to PVTG


    BIKASH SUKAMAJHI ST No

    Scheduled Tribe Name Applicant Gender


    Kandha Male

    Religion Date of Birth Aadhaar No.


    Christians 14 Mar 2007 (17 Year) XXXXXXXX6310
     Bank account is seeded with Aadhaar when applied by student.

    Mobile No. Alternative Mobile No. e-Mail Id


    8280235244 8280235244 [email protected]

    Father's Name Father Educational Status Father Occupational Status


    Najara Sukamajhi Literate Agriculture

    Mother's Name Mother Educational Status Mother Occupational Status


    Priya Sukamajhi Literate House Wife

    Guardian Name Individual/ Family Information


    VIEW
    Najara Sukamajhi Beneficiary of NFSA

    Address Information

    District Block/ULB GP/Ward


    Kandhamal Kotagarh Madaguda

    Village Pin Code Address


    Nadibetipadar 762105 AT-NADIBERIPADAR PS-TUMUDIBANDHA DIST-
    KANDHAMAL PIN-762105

    Educational Qualification Details

    For : Matric-Annual

    Course Board Roll No. Passing Year Total Mark/CGPA Secured Marks/CGPA Percentage (%) Marksheet/ Certificate

    X BSE, Odisha 027DD0023 2022 600 336 56.00 Uploaded

    Plus 2 CHSE, Odisha 118LB004 2024 600 257 42.83 Uploaded

    Institute / Course Information (Current Education Information)

    Institute Type
    Govt. Aided

    Institute District Block/ULB


    Netaji Subash Boss (Degree) College, Tumudibandha Kandhamal Tumudibandh
    Nature of Course Course Branch/Stream/Trade
    General Plus 3 Arts

    Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date


    1st Year 186 17 Jul 2024

    Enrollment No. Enrollment Date


    BA24-186 17 Jul 2024

    Any Exam Conducted during current academic year? : No

    Residential Status

    Whether
    Day Scholar

    Details of Last Exam Passed

    Course Course Year Passing Year


    Plus 2 2nd Year 2024

    Total Mark/CGPA Secured Marks/CGPA Percentage (%)


    600 257 42.83

    Certificate
    Uploaded

    Eligibility Information

    Income Certificate No. Family Income (in Rs.) To Whom the Certificate Issued
    E-INC/2024/1035248  75000.00 NAJARA SUKAMAJHI

    Issuing Authority Issue Date Income Certificate


    Revenue Officers not below the rank of Tahasildar / 23 Jun 2024 Uploaded
    Additional Tahasildar

    Matriculation Certificate No. Issuing Authority Matriculation Certificate


    222341017 BSE, Odisha (Annual) Uploaded

    Caste Certificate No. To Whom the Certificate Issued Issuing Authority


    E-STO/2024/429852  BIKASH SUKAMAJHI Revenue Officers not below the rank of Tahasildar /
    Additional Tahasildar

    Issue Date Caste Certificate


    25 Jun 2024 Uploaded

    Institute Declaration Certificate


    NA

    Bank Information

    Account Holder Name IFSC Code Account No.


    BIKASH SUKAMAJHI SBIN0004513 37237025036

    Whether account number tagged /seeded with the


    Aadhaar number?
    Yes

    Bank Name Branch Name


    STATE BANK OF INDIA KOTAGARH

    Passbook front page


    Uploaded
    Student Declaration

    1. I have read and understood the conditions of award of Scholarship.


    2. I am aware that my application is liable to be rejected, if it is found at any stage, that Aadhaar number provided by me is wrong or Aadhaar number is of
    someone’s else.
    3. I am aware that if more than one application is found, all my applications are liable to be rejected.
    4. I am aware that for any wrong entry or mis-match of the Bank-account details, the State Government will not be responsible for mis-credit and I will be held
    responsible for diversion of public money on this ground.

    Date ........................

    Place ........................ Full Signature of Applicant

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