Backward Classes & Minorities Welfare Dept.: Fresh Application

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

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4153481 Scheme : Post Metric Scholarship for OBC
Application ID: 6278524 First Time Lock Date: 16/08/2021
Version No: 1 Verification Code: 7444 Lock Date: 16/08/2021 IPAddress : 47.247.196.110
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 : [54204],VIVEKANAND PARAMEDICAL COLLEGE District: SHAHDOL Course : B.M.L.T./BMLT/1st Year [7801]
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 MANISHA RATHOUR MANEESHA RATHOUR
Father/ Husband Name GENDLAL RATHOUR Gendlal Rathour
DOB 13/10/2002 13/10/2002

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

Aadhar No. : XXXXXXXX6503
2. Details As Per Digital Caste Certificate : Reg No: RS/461/0106/13422/2014, Name : manisha rathour, Father I O
Name : gendlal rathour, Mother Name : mamta rathour, Category : OBC, Caste :
3.Academic Details As Repoted by Student : Enrollment No. : app21277238 Admission Date :11/12/2020 I O
Details As Repoted by Student Counselling Details

Admission Mode Direct Admission
Institute [54204],VIVEKANAND PARAMEDICAL COLLEGE

District: SHAHDOL
Course B.M.L.T./BMLT/1st Year [7801]
Academic Year 2020-21
Hostel Admission Non-Hosteler(Day-Scholar) --
Last Year Exam Details : Exam Name: higher secondry, Exam Date : 27/07/2020
I O
School./Institute :saraswti hshishu mandir jaitahri anuppur Result : pass
Error: Subreport could not be shown.
4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2017-2018, Roll No.: 183631103 I O
5. Total Annual Family Income : Rs.35000/- Income Certificate : issued by-tahsildar ON : 15/10/2020
Father/ Husband Occupation : Private Service, Income: 35000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
6. Contact Details Mobile No : 7879640317 rathourmanisha1310[AT]gmail[DOT]com I O

Correspondance Address : pasla pasla Pasala, District :- ANUPPUR
Permanent Address : , pasla pasla Pasala, District :- ANUPPUR

7. Bank Account No: 144701001492, IFS Code: ICIC0001447, ICICI BANK LTD, SHAHDOL, MADHYA PRADESH, I O
UMARIA
8. Change History NIL I O
Generated by Scholarship Portal as on 16/08/2021

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

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
]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian

1. We, MANISHA RATHOUR S/D/W/o GENDLAL RATHOUR and GENDLAL RATHOUR 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.
¡MANISHA RATHOUR S/D/W/o GENDLAL RATHOUR kGENDLAL RATHOUR Ȫȡȯ¡ɇ
ͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ Ē]_Ȣ¢ȡCBȪ[ȣ¢ȡȧȡ[ȢȡǓȡ]Ĥȡğɇ\ȡ`Ȳȡ\Û
ͪǗ[fȲ ¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯèȪͧȯͧfȯf¡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)
\ͧȡȡͪȡȯ¡èȡ¢Date ( ]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/ She has passed last exam and is eligible
for sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His / Her attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him/ her 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

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

Your 10th Board Details 10th

Board Name: MP Board of
Secondary Education, Year: 2017-
2018, Roll No.: 183631103
(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

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.: Fresh Application

Uploaded by

Copyright:

Available Formats

Ȫ\]ȪȪ_

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

Fresh Application Backward Classes & Minorities Welfare Dept.

Father/ Husband Name GENDLAL RATHOUR Gendlal Rathour

DOB 13/10/2002 13/10/2002

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

Details As Repoted by Student Counselling Details

Institute [54204],VIVEKANAND PARAMEDICAL COLLEGE

Academic Year 2020-21

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

6. Contact Details Mobile No : 7879640317 rathourmanisha1310[AT]gmail[DOT]com I O

Permanent Address : , pasla pasla Pasala, District :- ANUPPUR

8. Change History NIL I O

Generated by Scholarship Portal as on 16/08/2021

Fresh Application Backward Classes & Minorities Welfare Dept.

]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian

\ͧȡȡͪȡȯ¡èȡ¢ Date ( ]ȯȯ¡èȡ¢

(Signature ) (Signature ) Date (Signature )

Generated by Scholarship Portal as on 16/08/2021

Fresh Application Backward Classes & Minorities Welfare Dept.

Your 10th Board Details 10th

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

Generated by Scholarship Portal as on 16/08/2021

You might also like

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡSHAHDOL ȯ ͪ°ȡ[ãȡ Ʌ Ȳ[ ȯ¡Ȱ)

]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian

\ͧȡȡͪȡȯ¡èȡ¢Date ( ]ȯȯ¡èȡ¢

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