Application form for Post Matric Scholarship Application form for Post Matric Scholarship Print Print Pdf

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Applicant Detail Applicant Detail Applicant No.: PM041426457515100 Applicant No.: PM041426457515100 (Session: (Session: ))
Correspondence Address Correspondence Address
Permanent Address Permanent Address
Education Detail (Description of the previous examination) Education Detail (Description of the previous examination)
Name and Description of the present Institution Name and Description of the present Institution
Name of the class/Course for which the scholarship is demanded Name of the class/Course for which the scholarship is demanded
Scholarship Details Scholarship Details
Fees Details Fees Details Details of compulsory fees and other respective Details of compulsory fees and other respective expences of the present session expences of the present session
Description of the Bank of the College Description of the Bank of the College
Description of the Bank of the Student Description of the Bank of the Student
Certificate Upload Certificate Upload
BACKWARD CLASSES AND EXTREMELY BACKWARD CLASSES WELFARE DEPARTMENT
(GOVERNMENT OF BIHAR)
(New/Renewal) : Renewal Applicant Name : SHAILENDRA KUMAR
Date Of Birth : 05-Feb-1995 Name of father/Guardian: YOGENDRA ROY
Age: 19 Marital Status : Unmarried
Nationality : Indian Gender : Male
Email Id : soleroy2014@gmail.com Mobile No. : 9729308840
Caste Category : Extremely Backward Class Sub Caste : Amat
Guardian Annual Income : 47000
Address : AT THADHI P.O.THADHI VIA LADANIA DISTT. MADHUBANI BIHAR
Pincode No : 847232
Rural/Urban : Rural State : Bihar
District : Madhubani Circle / Block : Ladania
Address : AT THADHI P.O.THADHI VIA LADANIA DISTT. MADHUBANI BIHAR
Pincode No : 847232
# Course Name University Name/Recognized By Passing Year Total Marks Marks Obtained Division Mark(%)
1 INTERMEDIATE EXAM. BIHAR SCHOOL EXAMINATION BOARD,PATNA 2012 500 322 1 64.4
State : Haryana District : Ambala
University Name/Recognized By: KURUKSHETRA UNIVERSITY,KURUKSHETRA Institute/College Name:
E-MAX INSTITUDE OF ENGINEERING AND
TECHNOLOGY,AMBALA
Address:
6KM,FROM KALPI TOWARDS NARAINGARH,
VILLAGE BADHAULI DISTT.AMBALA,HARYANA
Institute Type: Private
Pincode: 134203
Institute Contact No: 9355703900 Institute Email id: emaxcollege@yahoo.com
Date of Admission : 08/05/2013
Name of the course : B-TECH Period of the Course : 4
Session of class/Course: 20132014 Present Year of Study: Ist Year
Has the applicant got scholarship in previous year under this scheme : No
If yes, the year of sanction of the scholarship :
Amount of the Scholarship :
Name of the office/officer who sanctioned the scholarship :
Address of the office/officer who sanctioned the scholarship :
Is applicant getting any other scholarship ? : No
Is applicant`s brother/sister getting any other scholarship ? : Yes
If Yes, How many brother/sister getting scholarship ? : 1
Name of the Institute who is providing scholarship ? : DISTRICT SOCIAL WELFARE MADHUBANI BIHAR-847211
# Particular Rate Amount paid Remarks
1 Tution fees 53000 53000 PAID
2 Non Refundable Compulsory fees 26520 26520 PAID
Total: 79520
Name of the Bank : Axis Bank IFSC Code of the Bank : UTIB0001758
Account Number: 912010020730526 Name of the Account Holder:
E-MAX SCHOOL OF ENGINEERING AND APPLIED
RESEARCH
Name of the Bank : punjab national bank IFSC Code of the Bank : PUNB0241500
Account Number: 2415001500003083 Name of the Account Holder: SHAILENDRA KUMAR
# Document Type Issue/Sr. Number Issuing Authority Date Of Issue
1 Last Passed Examination Marksheet 620982023209 B.S.E.BOARD,PATNA 06/05/2012
2 Cast Certificate CST/D20O09/2/155 C.O.LADANIA MADHUBANI,BIHAR 02/14/2013
3 Income Certificate INC/D20O09/2/78 C.O.LADANIA MADHUBANI,BIHAR 02/14/2013
4 Resident Certificate RSD/D20O09/2/186 C.O.LADANIA MADHUBANI,BIHAR 02/14/2013
5 Declaration of parent NA PARENT 10/10/2013
6 Certificate Of Fee Structure NA E-MAX ACCOUNT OFFICER 09/03/2013
7 Institution's Recognisation Certificate 1504599872/2013 AICTE,NEW DELHI,MINISTRY OF HRD,GOVT.OF INDIA 03/19/2013
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Applicant No.: PM041426457515100
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