Government of Odisha

State Scholarship Portal

Scholarship Application Form
Application Number : 2077514 Fresh Application Scheme : Post Matric Scholarship-OBC/SEBC

Personal Details

Name : HIMANSU SEKHAR BEHERA Gender : Male

BHAGIRATHI BEHERA Mother's Name : SATYABHAMA BEHERA
Father's Name :
Annual Income : Rs.45000/- Date of Birth : 05/06/1992
Category : OBC / SEBC Religion : Hindu
Special Category : No ADHAAR Card No. : 3131/2140/1368
Caste Certificate e-SEB/1548 of 2017 & 18/09/2017 Caste Certficate tahasildar
No. & Date : Issued by :

Academic Details
Institute : CENTRAL UNIVERSITY OF ORISSA Tehsil / District : Koraput /Koraput
Course : B. Ed. / B. Ed. First Year Academic Year : 2017 - 18
Hosteller : Yes 10th Class Details: Orissa State Board /2007 /67SC012
Hostel Admission 25/07/2017 Last Exam 54.42
Date: Percentage:
Enrolment No. and 17/03/DEDN13 & 18/07/2017 Admission date for 18/07/2017
Date : Academic year(2017
- 18) :

Contact Details :
Correspondence BOYS HOSTEL Permanent ADIA
Address CENTRAL UNIVERSITY OF ODISHA Address BONTH, DISTRICT :- Bhadrak ,
KORAPUT, DISTRICT :- Koraput , STATE :- Odisha , PIN CODE :-
STATE :- Odisha , PIN CODE :- 763001 756114
Contact Numbers : 7205084136 Email Address : himansubehera02@gm
ail.com

Bank Details :
IFSC Code : BKID0005350
Bank Name : BANK OF INDIA Branch Name : BALASORE, Baleswar (Balasore)
Branch Address: O.T.ROAD,BALASORE, - 756 001. Account Number : 535010110009191

Declaration
I, HIMANSU SEKHAR BEHERA S/o BHAGIRATHI BEHERA 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 20/10/2017