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PROFORMA TO BE SUBMITTED BY THE STYDENT FOR

PRATIBHA AWARD-2015

1. Name of the Student


2. Father Name
3. Name of the College where the student
has appeared final year Degree
Examination
4. Name & Residential Address of the
parent
5. Phone No

: SOUDU SANKARA RAO

: SANGAMA NAIDU
: SRI SAI DEGREE COLLEGE - BOBBILI

: AMITY (PO)(VILL), THERLAM(MD)


VIZIANAGARAM
: 9000039418

6. Name of the College/ Institution


of present studying

: RAJAH R S R K RR PG COLLEGE - BOBBILI

7. Name of the course

: B.A (HEP)

8. Admission No.

: 190 / 2012

9. Adhar Card No.


10. Bank Account No. of the student and
IFSC code ( Xerox copy of Pass book 1 st

: 635048173936
: 20140131126 SBI- THERLAM
IFSC CODE SBIN0002799

page), Bank name, Branch.

Signature of the student

Signature of the Principal


with stamp

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