Backward Classes & Minorities Welfare Dept.: Fresh Application

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Fresh Application Backward Classes & Minorities Welfare Dept.

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2018-19
Applicant Unique ID: 2994177 Scheme : Post Metric Scholarship for OBC
Application ID: 4111058 First Time Lock Date: 27/12/2018
Version No: 2 Verification Code: 6107 Lock Date: 28/12/2018 IPAddress : 182.70.153.42
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 : [20220],Laxmi Narayan College of Technology Jabalpur District: Course : B E [Full Time]/Computer Science and
JABALPUR Engineering/1st Year [3013]
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 SHWETA SONI SHWETA SWATI SONI
Father Name RAMESHKUMAR RAMESH KUMAR Ramesh Soni
DOB 03/02/2000 03/02/2000 21/09/2002

Gender Female[Ǒ¡ȡ% Female #Ǒ¡ȡ%
Category OBC #\ͪ% OBC #\ͪ% General # ȡȡÛ%
Religion : Hindu Special Category : No Voter ID : -- I O

Aadhar No. : XXXXXXXX1777
2. Caste Certificate for OBC : Issued by :SDM Katni, MPVide No: 3958 Dated :16/04/2011 I O
3.Academic Details As Repoted by Student : Enrollment No. : 0217CS18106 Admission Date :18/09/2018 I O
Details As Repoted by Student Counselling Details

Admission Mode Direct Admission
Institute [20220],Laxmi Narayan College of Technology Jabalpur

District: JABALPUR
Course B E [Full Time]/Computer Science and Engineering/1st
Year [3013]
Academic Year 2018-19
Hostel Admission Non-Hosteler(Day-Scholar) --
Last Year Exam Details : Exam Name: TWELVETH, Exam Date : 14/05/2018
I O
School./Institute :KUNDAN DAS H S SCHOOL KATNI Result : PASS
School Scholarship Details Generated From Samagra Portal
Name : SWATI SONI Category : Gen DOB : XXXXXX2002 Gender : Female
Father Name : RAMESH SONI BPL : ¡ȣȲ CWSN : No
Sno Academic Year School Current Class

1 2018-19 AIDED HSS KUNDANDAS SHANTI NAGAR 11 th
2 2017-18 AIDED HSS KUNDANDAS SHANTI NAGAR 10 th
3 2016-17 SHANTI NAGAR PRATHMIC SCOOL SHANTI NAGAR KATNI 9 th
6 2013-14 SHANTI NAGAR PRATHMIC SCOOL SHANTI NAGAR KATNI 3 rd
4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2015-16, Roll No.: 167225211 I O
5. Total Annual Family Income : Rs.36000/- Income Certificate : issued by-TEHSEELDAR KATNI ON : 08/06/2018
Father/ Husband Occupation : Father is No More, Income: 0/-
Generated by Scholarship Portal as on 06/01/2019

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Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
6. Contact Details Mobile No : 9669212673 SHWETASONIKTN01[AT]GMAIL[DOT]COM I O

Correspondance Address : BAJRANG NAGAR HOUSING BOARD COLONY KATNI, District :- KATNI
Permanent Address : BAJRANG NAGAR HOUSING BOARD COLONY KATNI, District :- KATNI
7. Bank Account No: 3231275121, IFS Code: CBIN0280747, CENTRAL BANK OF INDIA, TIKURI FACTORY TOWNSHIP, I O
KATNI
8. Change History NIL I O

ALERT: Details of Applications already registered by using same Samagra ID :
Nil
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil
]ȯfȲȡȧȪȡDeclaration From Student and his Parent

1. We, SHWETA SONI S/o RAMESHKUMAR and RAMESHKUMAR 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.
¡SHWETA SONI S/o RAMESHKUMAR kRAMESHKUMAR Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ Ē]_Ȣ¢ȡ
CBȪ[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.
The institute is accredited by the Government and permission is given to conduct related course.
(Signature ) (Signature ) Date (Signature )

Scholarship Nodal Officer HOD Director/Prinicpal


Your 10th Board Details 10th

Board Name: MP Board of
Secondary Education, Year: 2015-
16, Roll No.: 167225211


Caste Certificate Details Issued

by :SDM Katni, MPVide No: 3958
Dated :16/04/2011
(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.: Fresh Application

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Fresh Application Backward Classes & Minorities Welfare Dept.

Father Name RAMESHKUMAR RAMESH KUMAR Ramesh Soni

DOB 03/02/2000 03/02/2000 21/09/2002

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

Details As Repoted by Student Counselling Details

Institute [20220],Laxmi Narayan College of Technology Jabalpur

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

Sno Academic Year School Current Class

Generated by Scholarship Portal as on 06/01/2019

Fresh Application Backward Classes & Minorities Welfare Dept.

6. Contact Details Mobile No : 9669212673 SHWETASONIKTN01[AT]GMAIL[DOT]COM I O

8. Change History NIL I O

]ȯfȲȡȧȪȡDeclaration From Student and his Parent

(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 06/01/2019

Fresh Application Backward Classes & Minorities Welfare Dept.

Your 10th Board Details 10th

Generated by Scholarship Portal as on 06/01/2019

Fresh 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 06/01/2019

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]ȯfȲȡȧȪȡDeclaration From Student and his Parent

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

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