Government of Odisha

State Scholarship Portal

Scholarship Application Form
Application Number : 572703 Renewal Application Scheme : Post Matric Scholarship- SC

Personal Details

Name : SWORNAPRAVA TARAI Gender : Female

SAMIRA TARAI Mother's Name : SUKANTI TARAI
Father's Name :
Annual Income : Rs.245360/- Date of Birth : 04/02/1995
Category : SC Religion : Hindu
Special Category : No ADHAAR Card No. : 7919/8932/3652
Caste Certificate e-CAS/1013 & 15/07/2016 Caste Certficate REVENUE OFFICER
No. & Date : Issued by :

Academic Details
Institute : Govt. Hindi Teachers Training Institute Tehsil / District : Cuttack /Cuttack
Cuttack
Course : B.H. Ed (Bachelor in Hindi Second Academic Year : 2017 - 18
Education) / Hindi Education Year
Hosteller : Yes 10th Class Details: Orissa State Board /2010-11 /19RA214
Hostel Admission 09/09/2016 Last Exam 65.61
Date: Percentage:
Enrolment No. and 033 & 09/09/2016 Admission date for 02/08/2017
Date : Academic year(2017
- 18) :

Contact Details :
Correspondence C/O - SAMIRA TARAI AT - Permanent C/O - SAMIRA TARAI AT -
Address ACHHUTADASPUR PO- JAPA, Address ACHHUTADASPUR PO- JAPA,
DISTRICT :- Jagatsinghpur , STATE :- DISTRICT :- Jagatsinghpur , STATE :-
Odisha , PIN CODE :- 754139 Odisha , PIN CODE :- 754139
Contact Numbers : 9861293068 Email Address : manastarai45@gmail.c

Bank Details :
IFSC Code : SBIN0008090
Bank Name : STATE BANK OF INDIA Branch Name : BHITHARANDHARI,
JAGATSINGHPUR
Branch Address:
DIST : JAGATSINGHPUR, 754141 Account Number : 30826852217

Declaration

Generated by Scholarship Portal as on 12/9/2017

 Government of Odisha
State Scholarship Portal
Scholarship Application Form
Application Number : 572703 Renewal Application Scheme : Post Matric Scholarship- SC

I, SWORNAPRAVA TARAI S/o SAMIRA TARAI hereby declare that the information given in the application form are true as per best
of my knowledge and belief. I also undertake that if, at any stage, it is found to the satisfaction of the sanctioning authority that the
information given by me is false, the entire amount of scholarship will be recovered from as arrears of land revenue or any other law in
force apart from such penal action as warranted by law. I have not applied for /in receipt of any other scholarship from Govt of
India/Govt of Orissa.

Check List
Document to be attached : -

1. Caste Certificate issued from the competent authority

2. Residential Certificate
3. Income Certificate from the concerned authorized authority/Persons
4. H.S.C Certificate (Photo Copy) Attested by Competent authority
5. Photo Copy of the first page of Bank Passbook having account no
6. Income declaration of parents/guardian from all the sources on non-judicial stamp paper
(Signature)

Generated by Scholarship Portal as on 12/9/2017