Backward Classes & Minorities Welfare Dept.: Version No: 1 Verification Code: 9925 Lock Date: 15/10/2018 Ipaddress

Ȫ\]ȪȪ_
èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡREWA ȯ ͪ°ȡ[ãȡ

Ʌ Ȳ[ ȯ¡Ȱ)
Renewal Application Backward Classes & Minorities Welfare Dept.

Madhya PradeshScholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2018-19
Applicant Unique ID : 1512223
Scheme : Post Metric Scholarship for OBC
Application ID: 3748120
Version No: 1 Verification Code: 9925 Lock Date: 15/10/2018 IPAddress : 106.79.236.190
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.
1. Personal Details SAMAGRA ID : 113824787 Aadhaar No : XXXXXXXX0621 Voter ID : WZA2157774
Name : ANAMIKA PATEL As per SAMAGRA: Anamika Patel
Gender : Female Religion : Hindu Special Category : No
Father's Name : ganga ** Colleges / District Offices are requested to verify Board name,Passing year
and Roll No. from student original 10th Marksheet
Mother's Name : nirmla
I O
Date of Birth : 12/08/1987
2.Category OBC
Caste Certificate : No: 70633 by :Tehsil Office Sirmour On :26/03/2007 I O
3.Academic Details Admission Date : 25/07/2018 Enrollment No. : 132241580097 I O
University/Board Name : Awadhesh Pratap Singh University, Rewa
Institute : 47548-Shivaji Shiksha Mahavidhyalay District: REWA
Course : 9903/B.ED.(2 Yr.)/B.ED./2nd Year
Hostel Status: Day Scholar
4. 10th Board Details 10th Board Name: MP Sanskrit Board, Year: 2005-06, Roll No.: 5151602758
School Scholarship Details Generated From Samagra Portal

Name : ANAMIKA PATEL Category : OBC DOB : XXXXXX1987 Gender : Female
Father Name : GANGA PATEL BPL : ¡ȣȲ CWSN : No
School Scholarships details not available
5. Last Year Exam Details : Exam Name: 9903/B.ED.(2 Yr.)/B.ED./1st Year, Exam Date : 06/09/2018 I O
School./Institute :Shivaji Shiksha Mahavidhyalay Result : Promoted to next higher Course Year
(Pass/ATKT)
6. Total Annual Family Income : Rs.40000/-

Income Certificate issued by-Revenue Department On : 26/09/2016
7 Contact Details Mobile No : 7771802988 annupoly01[AT]gmail[DOT]com I O
Correspondance Address : vill and post godari, District :- REWA
Permanent Address : vill and post godari, District :- REWA

8. Bank Account No: 764402010000541, IFS Code: UBIN0576441, UNION BANK OF INDIA, LALGAON REWA, REWA I O
9. Previous Year Sanction Order Details Application ID : 3147046
I O
Sanction Order No.: 1155077, Sanction Order Date: 14/03/2018, Sanction Amount: Rs.8390/-
Generated by Scholarship Portal as on 15/10/2018

Ȫ\]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡREWA ȯ ͪ°ȡ[ãȡ
Ʌ Ȳ[ ȯ¡Ȱ)

]ȯfȲȡȧȪȡDeclaration from Student and his Parent
ɇANAMIKA PATEL s/w/o ganga ȪȡȡȢ¡ǗȱͩȡğǙǓȢȢȧhȡ^]ȯȨ[ȯȣ_ Ȣ
ȡȡǐɉǔ ȯǕÉǾ ȯȯȡȡȡȡͪȡȡȡ10th Board ȧȡȡȣȯ\Ǖ ȡ[ǓĤȡğȯ\Ǖ ȡͧȲ
]ȡȲ[ȡȣ¢ȡǐȡ] ȲȲȢȡȡȣ]Ĥȡğȯ\Ǖ ȡ[ȡȯ\ÚȪ [Ȫ [ȡ[ɇȡȯ
ĤȯȡĤȡfȲ Ȳèȡ ȲȲȢȡȡȣ ¡ȣfȲ ×¡ȰfȲȪ[èȡȯ«ȯǾȯ\Ȫȧ_¡Ȱ)ɇ[ȡȰ¢ͨ ğȯ
ȯf¡ȣĤȡȧèȨͧ[ȯͧf]ȯͩȡ¡Ǘȱ)Ǒ^ȯ ȯȪ_Ȣȡȡȣ\ ×ȡğǕǑǗ[ȡ_ȡȢ¡ȰȪȯȡȡğǙǓ
]ȯȡ[ ȲèȡèȢǙǓȡ[\ͬȡȣͪȡƮȡȡǓèͩfȡȯɇèȡȡ¡Ǘȱȡ¡ǗȱȢ)ȡ ȯȯͪǽƨ¤ȡǗȢ
ȡ[ȡ¡ȣȯȯͧfèȲğ¡Ȫȡ)
ɇȪ [Ǘ[¡Ȫȯȯ¡ȯȪ [ ȲèȡȪ°ȯȡȯȢ¡ǗȱȪ¡ȯȣǗ[ǔàȯȡȣ¡ȪȢͩȯȯƮȡȡǗ[Ʌ ȲȲͬȪ [ȯͧȯĤȡƯ
ȡğǙͪƣȡ Ȫ ȲȲͬǔȡȡȡ[ȯȡÚ ȯȡȡ ȯȡ ǗȲȡǗȲȢ)ȡğǙͪƣȡ ȯͩǔèǓɅȡ ȯȯ
ͪǾƨȪ_Ȣȡȡ[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 student is enrolled in college in the course approved/recognized by concerned board/council/university. All details filled
by student in above application form have been verified with original documents & have been found to be correct / authentic. Applicant has
promoted to next higher course year(Pass/ATKT). College has ORIGINAL COPY of his Transfer Certificate. Applicant is not enrolled in another
institute. Applicant's attendance is regular.
We have verified all details as per 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 it on portal and
to 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 legal and penal action against the institute.
(Signature ) (Signature ) Date (Signature )

Scholarship Nodal Officer HOD Director/Prinicpal
Income Certificate Details

Ȫ\]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡREWA ȯ ͪ°ȡ[ãȡ
Ʌ Ȳ[ ȯ¡Ȱ)

Previous Year MarkSheet
Fees Receipt/ Admission Slip
(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢
Ȫȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)
Ǒ]Øɉȯ]ȡȡğǙǓȯȯ¡Ǖ]ȡfȯȪ]ȧȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢȣ_¡Ȱ` ȯ
ȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢȡğǙͪƣ ȯͪǔ[(Debarred)
ǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ(Black List) ɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[\ͬȡȣ\ȡ\Û ¢\ͬȡȣ]æ
ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲȯ¡f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧ
ȡȯȢ)

Backward Classes & Minorities Welfare Dept.: Version No: 1 Verification Code: 9925 Lock Date: 15/10/2018 Ipaddress

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Backward Classes & Minorities Welfare Dept.: Version No: 1 Verification Code: 9925 Lock Date: 15/10/2018 Ipaddress

Uploaded by

Copyright:

Available Formats

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡREWA ȯ ͪ°ȡ[ãȡ

Renewal Application Backward Classes & Minorities Welfare Dept.

School Scholarship Details Generated From Samagra Portal

School Scholarships details not available

6. Total Annual Family Income : Rs.40000/-

Permanent Address : vill and post godari, District :- REWA

Generated by Scholarship Portal as on 15/10/2018

Renewal Application Backward Classes & Minorities Welfare Dept.

(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢

Declaration from Institute Head & Institute Scholarship Nodal Officer

(Signature ) (Signature ) Date (Signature )

Income Certificate Details

Generated by Scholarship Portal as on 15/10/2018

Renewal Application Backward Classes & Minorities Welfare Dept.

Previous Year MarkSheet

Fees Receipt/ Admission Slip

(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢

Generated by Scholarship Portal as on 15/10/2018

You might also like

Backward Classes & Minorities Welfare Dept.: Version No: 1 Verification Code: 9925 Lock Date: 15/10/2018 Ipaddress

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Backward Classes & Minorities Welfare Dept.: Version No: 1 Verification Code: 9925 Lock Date: 15/10/2018 Ipaddress

Uploaded by

Copyright:

Available Formats

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡREWA ȯ ͪ°ȡ[ãȡ

Renewal Application Backward Classes & Minorities Welfare Dept.

School Scholarship Details Generated From Samagra Portal

School Scholarships details not available

6. Total Annual Family Income : Rs.40000/-

Permanent Address : vill and post godari, District :- REWA

Generated by Scholarship Portal as on 15/10/2018

Renewal Application Backward Classes & Minorities Welfare Dept.

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

Declaration from Institute Head & Institute Scholarship Nodal Officer

(Signature ) (Signature ) Date (Signature )

Income Certificate Details

Generated by Scholarship Portal as on 15/10/2018

Renewal Application Backward Classes & Minorities Welfare Dept.

Previous Year MarkSheet

Fees Receipt/ Admission Slip

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

Generated by Scholarship Portal as on 15/10/2018

You might also like

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡREWA ȯ ͪ°ȡ[ãȡ

(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢

(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢