Backward Classes & Minorities Welfare Dept.: Renewal Application

Ȫ\]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡVIDISHA ȯ ͪ°ȡ[ãȡ Ʌ Ȳ[ ȯ¡Ȱ)
Renewal Application Backward Classes & Minorities Welfare Dept.

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2017-18
Applicant Unique ID: 1710287 Scheme : Post Metric Scholarship for OBC
Application ID: 2544551 First Time Lock Date: 17/10/2017
Version No: 1 Verification Code: 3971 Lock Date: 17/10/2017 IPAddress : 182.173.64.246
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sign in it.
Institute : [20379],Samrat Ashok Technological Institute (Degree), Vidisha District: Course : B E [Full Time]/Mechanical Engineering/3rd
VIDISHA Year [3031]
NOTE :- The Student is Claiming the fee & maintenance allowance for same level of course & same Course YearPrevious
Institute:20379-Samrat Ashok Technological Institute (Degree), Vidisha Previous Course:3031-Mechanical Engineering/B E
[Full Time] Previous Course Year:Second Year
Old Scholarship Details(Before 2014-15 No Post Metric Scholarship was sanctioned Last Year.
Details Application Form 10th Board Data Samagra Data Counselling Data
Name AJAY KUMAR KATRE AJAY KUMAR KATRE AJAY KATRE
Father Name SHERSINGH SHER SINGH Shersingh Katre
DOB 11/05/1996 11/05/1996 11/05/1996

Gender Male #Ǖǽ% Male #Ǖǽ%
Category OBC #\ͪ% OBC #\ͪ% OBC #\ͪ%
Religion : Hindu Special Category : No Voter ID : TCP1687938 I O

Aadhar No. : 665555284140
2. Caste Certificate for OBC : Issued by :Office of SDO(Revenue) Seoni, MPVide No: 00 Dated :22/08/2008 I O
3.Academic Details As Repoted by Student : Enrollment No. : 0108ME163D01 Admission Date :11/08/2016 I O
Details As Repoted by Student Counselling Details

Admission Mode Centralized Counselling
Institute [20379],Samrat Ashok Technological Institute (Degree),

Vidisha District: VIDISHA
Course B E [Full Time]/Mechanical Engineering/3rd Year
[3031]
Academic Year 2017-18
Hostel Admission Non-Hosteler(Day-Scholar) --
Last Year Exam Details : Exam Name: Third Semester, Exam Date : 22/02/2017
I O
School./Institute :20379 Result :
Post Metric Scholarship Details Generated From Scholarship Portal
S.No Academic Institute Course Br Yr Scheme Admission Hostel TFW Income

Mode status
1 2014-15 20127-Polytechnic 82-DIPLOMA OBC Centralized No No 40000
College, Seoni [PPT]/7312-
Mechanical
Engineering/2nd
Year
2 2015-16 20127-Polytechnic 82-DIPLOMA OBC Centralized No Yes 30000
College, Seoni [PPT]/7312-
Mechanical
Engineering/3rd
Year
3 2016-17 20379-Samrat Ashok 63-B E [Full OBC Centralized No No 30000
Technological Institute Time]/3031-
(Degree), Vidisha Mechanical
Engineering/2nd
Year
Generated by Scholarship Portal as on 17/10/2017

School Scholarship Details Generated From Samagra Portal
Name : AJAY KATRE Category : OBC DOB : XX/XX/1996 Gender : Male
Father Name : SHERSINGH KATRE Aadhar No.: XXXXXXXX0554 BPL : ¡ȣȲ CWSN : No
School Scholarships details not available
4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2012-13, Roll No.: 137729677 I O
5. Total Annual Family Income : Rs.30000/- Income Certificate : issued by-Revenue Department ON : 16/11/2015
Father/ Husband Occupation : Farmer / Agriculture, Income: 30000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
6. Contact Details Mobile No : 8349976088 ajaykatre22[AT]gmail[DOT]com I O

Correspondance Address : VILLAGE KARKOTI POST CHINBARRI, District :- SEONI
Permanent Address : VILLAGE KARKOTI POST CHINBARRI, District :- SEONI

7. Bank Account No: 1413108018796, IFS Code: CNRB0001413, CANARA BANK, SEONI, SEONI I O
8. Change History NIL I O
ALERT: Details of Applications already registered by using same Samagra ID :
Applicant Unique ID: 1710287, Application ID: 1923151, Applicant Name: AJAY KATRE, DOB:11/05/1996, Father
Name:SHERSINGH, Gender:Male, Category:OBC, Mobile:8349976088, Institue:Samrat Ashok Technological Institute
(Degree), Vidisha, Branch:Mechanical Engineering, Year:Second Year, Application Date:20/10/2016, Applicant Unique ID:
1710287, Application ID: 630678, Applicant Name: AJAY KATRE, DOB:11/05/1996, Father Name:SHERSINGH,
Gender:Male, Category:OBC, Mobile:8349976088, Institue:Polytechnic College, Seoni, Branch:Mechanical Engineering,
Year:Second Year, Application Date:04/03/2015, Applicant Unique ID: 1710287, Application ID: 817756, Applicant Name:
AJAY KATRE, DOB:11/05/1996, Father Name:SHERSINGH, Gender:Male, Category:OBC, Mobile:8349976088,
Institue:Polytechnic College, Seoni, Branch:Mechanical Engineering, Year:Third Year, Application Date:05/11/2015
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil


]ȯfȲȡȧȪȡDeclaration From Student and his Parent
1. We, AJAY KUMAR KATRE S/o SHERSINGH and SHERSINGH hereby declare that Board Roll No, Samagra ID, caste certificate and income
certificate, bank account details and all other information given in the application form is complete and correct. We have not submitted any other
application for scholarship for current academic year in any other institution in India. We also undertake that, if any information given above is found to
be false at any stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal action against us.
¡AJAY KUMAR KATRE S/o SHERSINGH kSHERSINGH Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ Ē]_Ȣ¢ȡCB
Ȫ[ȣ¢ȡȧȡ[ȢȡǓȡ]Ĥȡğɇ\ȡ`Ȳȡ\ÛͪǗ[fȲ ¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯ
èȪͧȯͧfȯf¡ȣ]ȯͩȡ¡Ȱ@\`ȪƠȡȡȣȡ_ȡȢ¡ȰȪ¡]ȯǓè¡ȪȡȯȡfȲȡͧȡͪ
ȣȡȯȢfȲ¡ȡȯͨȡȡǗȢȡ[ȡ¡ȣȧȡȯȢ@
Ǒ]Øɉȯ]ȡȡğǙǓȯȯ¡Ǖ]ȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢȣ_
¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢȡğǙͪƣ
ȯͪǔ[
ȢȡǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ
ÞȰͧèɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[\ͬȡȣ\ȡ
\Û ¢\ͬȡȣ]æ ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲȯ¡
f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧȡȯȢ)
ɇȪ [Ǘ[¡Ȫȯȯ¡ȯȪ [ ȲèȡȪ°ȯȡȯȢ¡ǗȱȪ¡ȯȣǗ[ǔàȯȡȣ¡ȪȢȧȯȯƮȡȡǗ[Ʌ ȲȲͬȪ [ȯͧȯĤȡƯ
ȡğǙͪƣȡ Ȫ ȲȲͬǔȡȡȡ[ȯȡÚ ȯȡȡ ȯȡ ǗȱȡǗȲȢ)ȡğǙͪƣȡ ȯȧǔèǓɅȡ ȯȯ
ͪǽƨȪ_Ȣȡ[ȡ¡ȣȯȯͧȯèȲğ¡ȯȡ)
(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢

Declaration from Institute Head & Institute Scholarship Nodal Officer
We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He has passed last exam and is eligible for
sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him for sanction of scholarship as per the rules. We also
undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter to the
concerned district office so that his scholarship can be put on hold. In case any information of found to be incorrect, Government will be free to
initiate action against the institute.
(Signature ) (Signature ) Date (Signature )

Scholarship Nodal Officer HOD Director/Prinicpal


Your 10th Board Details 10th

Board Name: MP Board of
Secondary Education, Year: 2012-
13, Roll No.: 137729677


Caste Certificate Details Issued

by :Office of SDO(Revenue)
Seoni, MPVide No: 00 Dated
:22/08/2008
(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢
Ȫȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)

Backward Classes & Minorities Welfare Dept.: Renewal Application

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Ȫ\]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡVIDISHA ȯ ͪ°ȡ[ãȡ Ʌ Ȳ[ ȯ¡Ȱ)

Renewal Application Backward Classes & Minorities Welfare Dept.

Father Name SHERSINGH SHER SINGH Shersingh Katre

DOB 11/05/1996 11/05/1996 11/05/1996

Religion : Hindu Special Category : No Voter ID : TCP1687938 I O

Details As Repoted by Student Counselling Details

Institute [20379],Samrat Ashok Technological Institute (Degree),

Hostel Admission Non-Hosteler(Day-Scholar) --

Post Metric Scholarship Details Generated From Scholarship Portal

S.No Academic Institute Course Br Yr Scheme Admission Hostel TFW Income

Renewal Application Backward Classes & Minorities Welfare Dept.

School Scholarships details not available

6. Contact Details Mobile No : 8349976088 ajaykatre22[AT]gmail[DOT]com I O

Permanent Address : VILLAGE KARKOTI POST CHINBARRI, District :- SEONI

Generated by Scholarship Portal as on 17/10/2017

Renewal Application Backward Classes & Minorities Welfare Dept.

(Signature of Parent / ȡͪȡȯ¡èȡ¢ Date (Signature of Student / ]ȯȯ¡èȡ¢

(Signature ) (Signature ) Date (Signature )

Generated by Scholarship Portal as on 17/10/2017

Renewal Application Backward Classes & Minorities Welfare Dept.

Your 10th Board Details 10th

Generated by Scholarship Portal as on 17/10/2017

Renewal Application Backward Classes & Minorities Welfare Dept.

Caste Certificate Details Issued

(Signature of Parent / ȡͪȡȯ¡èȡ¢ Date (Signature of Student / ]ȯȯ¡èȡ¢

Generated by Scholarship Portal as on 17/10/2017

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