Personal

Last Exam Passed

Name: D M Sweta

Last Exam Passed: +2(Intermediate)

Email: swetalucy2796@gmail.com

Stream: Science

Mobile: 7381826967

Name of Board/Council/University: CBSE

Category: General

Name of College/Institution: KENDRIYA

VIDYALAYA NO.4

Religion: Hindu
Date of Birth: 1996-05-27
Sex: Female
Nationality: Indian
Mother Tongue: Odia
AadharCard Id (Optional): Voter Id Card (Optional): -

Address of College/Institution:
NILADRI VIHAR,CHANDRASEKHAR
PUR,BHUBANESWAR
Year of Entry: 2004
Year of Passing: 2015
Mark Type: MARKS
Mark/CGPA Secured: 335
Max Mark / CGPA: 500
Percentage: 67.00

Present Course & University /

College/ Institution Information
College Name: TRIDENT ACADEMY OF
TECHNOLOGY
Course Name: Technical & Professional

Applied Scholarship information

Scholarship Type: Students admitted from
All India Test pursuing higher technical/
Professional studies in reputed Nat
Scholarship Scheme:
PROFESSIONAL/TECHNICAL

Date of Admission: 2015-08-06

Name of Entrance: JEE
Course duration (in Year): 4
Roll No.: 28806021
Roll No.: 1501289144
All India Rank: 604007
Year of Exam: 2015

Parents / Guardian Information:

Father / Guardian Name: DILLIP KUMAR
BHATTA

Permanent Address
State: Odisha
District: KHURDA

Father's Profession: BUSINESS

Block/ULB: BHUBANESWAR
Father's Annual Income (in Rs.): 350000
House No./ Street/ Village: S-3,MIG-853
Mother's Name: MAMATA BHATTA
Post Office: SAILASHREE VIHAR
Mother's Profession: HOUSEWIFE
Pin Code: 751021
Mother's Annual Income (in Rs.): 0

Bank Account
Account Number: 2957108002041
Account Holder Name: D M Sweta
A/C Type: Personal
IFSC Number: CNRB 000 2957
Bank Name: Canara Bank
MICR Number: 751015007
(For online money transfer through RTGS/NEFT)

Bank Address: CANARA BANK,PLOT

326,DIST CENTRE,BEHD BPCL,NILADRI
VIHAR ROAD,BHUBANESWAR

Declaration

I do hereby declare that the above information furnished by me is true and correct to the best of
my knowledge and belief. I am not availing any scholarship from Government of Odisha in any
other.

Date _________________ Place

_______________

Full Signature of Applicant

Studentship Certificate by the Head of the Institution

Certified that Shri/Ms./Smt. _________________________ has been admitted this institute on
_____________ as a regular student of the course ______________________________
during the academic session ______________________ bearing Roll
No.____________________ His / Her rank in the Entrance Test conducted by
_________________________________________ is ________________________ On the
basis of which he/she has been admitted into this institution.

Date ________________________

Full Signature of Head of the Institution

with date & Seal

Essential Enclosures
The following documents needs to be submitted at the college/institution along with this
form
Slno

Documents

Self-Attested copy of Residential Certificate.

Self-Attested copy of income certificate of

parents from employer and /or appropriate
authority.

Self-Attested copy of certificate & mark sheet

of last qualifying examination.

Self Attested copy of the first page of Bank

Pass-Book showing name of the applicant &
account number.

Self-Attested copy of rank card issued by the

chairperson of OJEE/ALL India Test

Self-Attested copy of Aadhar Card / Voter Id

Card (if available with the student)

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