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˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡSHAHDOL €ȯ ]Ǒ‘ȡ Ȣͪ€ȡ žȡȡ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application SC Development Department

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4277540 Scheme : Post Metric Scholarship for SC
Application ID: 6278820 First Time Lock Date: 16/08/2021
Version No: 1 Verification Code: 2266 Lock Date: 16/08/2021 IPAddress : 157.34.222.20
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 MOHITDAS KABIRPANTHI MOHIT DAS MOHITDAS
KABIRPANTHI KABIRPANTH
Father/ Husband Name ISHWARDEEN LATE ISHWARDEEN Eshwardeen Chaudhary
KABIRPANTHI
DOB 24/12/2002 24/12/2002 24/12/2003
Gender Male #”ǕǽŸ%
Category SC #\“Ǖ Ǘͬ…‡ȡǓ% SC #\“Ǖ Ǘͬ…‡ȡǓ%

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

Aadhar No. : XXXXXXXX8750

2. Details As Per DigitalCaste Certificate : Reg No: RS/460/0104/1680/2021, Name : MOHIT DAS KABIRPANTHI, I O
Father Name : ISHWAR DEEN KABIRPANTHI, Mother Name : KESHKALI KABIRPANTHI, Category : Scheduled Caste, Caste
: Chamar

3.Academic Details As Repoted by Student : Enrollment No. : app21278446 Admission Date :30/01/2021 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 school, Exam Date : 15/12/2020
I O
School./Institute :govt girl h s school sohagpur shahdol 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.: 183325918 I O

5. Total Annual Family Income : Rs.25000/- Income Certificate : issued by-tahsildar ON : 02/02/2021
Father/ Husband Occupation : Father is No More, Income: 0/-
Mother Occupation : Private Service ,Income: 25000/- I O
Other Income : Rs.0/-

6. Contact Details Mobile No : 9399214598 MOHIT20202020[AT]GMAIL[DOT]COM I O

Correspondance Address : kodwar kala saamatpur Samatpur, District :- SHAHDOL

Permanent Address : , kodwar kala saamatpur Samatpur, District :- SHAHDOL

7. Bank Account No: 144701505688, 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

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Fresh Application SC Development Department

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4277540 Scheme : Post Metric Scholarship for SC
Application ID: 6278820 First Time Lock Date: 16/08/2021
Version No: 1 Verification Code: 2266 Lock Date: 16/08/2021 IPAddress : 157.34.222.20
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

]ȯ‘€fȲ\ͧ——ȡ€”ȡ›€€ȧƒȪŸŽȡDeclaration from Student and Parent/ Guardian

1. We, MOHITDAS KABIRPANTHI S/D/W/o ISHWARDEEN KABIRPANTHI and ISHWARDEEN KABIRPANTHI 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.
¡˜MOHITDAS KABIRPANTHI S/D/W/o ISHWARDEEN KABIRPANTHI kšISHWARDEEN KABIRPANTHI ƒȪŸŽȡ€šȯ¡ɇ
ͩ€`”šȪƠ‡ȡ“€ȡšȣ ¡ȣ¡ȰfȲ ˜Ē]_ŒȢ€¢ȡCB–ȪŒ[”šȣ¢ȡ€ȧ˜ȡ€[žȢŠ‡ȡǓȡ]™Ĥ˜ȡŽ”ğ–ɇ€\€ȡ`ȲŠȡ\ۙ
ͪšŽ”ǗŽ[fȲ ¡ȣ¡Ȱ@]ȯ‘€“ȯ”ȪŠ[›”š^  ğ˜ȯè€Ȫ›šͧž”€ȯͧ›f€ȯ›f€¡ȣ]ȯ‘“ͩ€™ȡ¡Ȱ@\‚š`”šȪƠ‡ȡ“€ȡšȣ‚›”ȡ_
‡ȡȢ¡ȰȪ™¡]ȯ‘“Ǔ“šè¡Ȫ‡ȡȯ‚ȡfȲšȡͧžȡͪ” ›ȣ‡ȡȯ‚ȢfȲ¡˜ȡšȯͨ›ȡ•€ȡ“Ǘ“Ȣ€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ@
™Ǒ‘]”‚›Ø™ɉ€ȯ]’ȡš”š†ȡğǙǓ›ȯȯ¡Ǖ]”ȡf‚™ȯȪ¡˜ȡšȣ†ȡğǙͪƣǓ“šè€š‘ȣ‡ȡȯ‚Ȣȡ†ȡğǙͪƣ€ȧǔ‡“Ȣš€˜‘ȣ‚_
¡Ȱ` ȯȡ” ›ȯ›ȣ‡ȡȯ‚Ȣ)^ š¡€ȯͩЙȡ€›ȡ” ȯ ˜ǔےͪ’ȡȸ€Ȫ¡˜ȯžȡ€ȯͧ›fͩ€ Ȣ—Ȣ™Ȫ‡“ȡ€ȯ\ۏ‚[ͩ€ Ȣ—Ȣ†ȡğǙͪƣ
 ȯͪǔ‡[
ŒȢȡš€šǑ‘™ȡ‡ȡ™ȯ‚ȡȡͪ’ȡȸ€Ȫ€ȡ›ȣ Ǘ…Ȣ
ޛȰ€ͧ›èŠ˜ɅŒȡ›Ǒ‘™ȡ‡ȡ™ȯ‚ȡȡ†ȡğǙͪƣèȢ€Ǚ€ȡ[\ͬ’€ȡšȣ\ȡ
\ۙ ¢˜\ͬ’€ȡšȣ]æ™€ ˜ˆȯ‚ɅȪ` €ȯͪǽڑ—ȡšȢ™‘ÖŒ ȲǑ¡ȡ€ȧ’ȡšȡjȲfȲ€ȯ¡
f•]_]š‘‡[€šȡ_‡ȡ€š É€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ)
˜ɇ€Ȫ [”ǗŽ[¡Ȫ“ȯ€ȯ”¡›ȯ€Ȫ [ Ȳèȡ†Ȫ°‘ȯȡ‘ȯȢ¡ǗȱȪ™¡˜ȯšȣ”ǗŽ[ǔ‡à˜ȯ‘ȡšȣ¡Ȫ‚Ȣ€ȧ˜ȯšȯƮȡšȡ”Ǘ[˜Ʌ Ȳ–Ȳͬ’€Ȫ [€ȯͧ›™ȯĤȡƯ
†ȡğǙͪƣžȡ “€Ȫ Ȳ–Ȳͬ’ǔ‡›ȡ€ȡ™ȡ[›™€ȯ˜ȡڙ˜ ȯ…ȡ›ȡ“ ȯȡ” €š‘Ǘȱ‚ȡ‘ǗȲ‚Ȣ)†ȡğǙͪƣȡ” “€š“ȯ€ȧǔèǓ˜Ʌžȡ “˜ȯšȯ
ͪǽƨ€Ȫ_—Ȣ€ȡ™[ȡ¡ȣ€š“ȯ€ȯͧ›™ȯ蝏Ȳğš¡ȯ‚ȡ)

\ͧ——ȡ€”ȡ›€ͪ”ȡ€ȯ¡èȡ¢šDate ( ]ȯ‘€€ȯ¡èȡ¢š

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

Generated by Scholarship Portal as on 16/08/2021

 “ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡSHAHDOL €ȯ ]Ǒ‘ȡ Ȣͪ€ȡ žȡȡ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application SC Development Department

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4277540 Scheme : Post Metric Scholarship for SC
Application ID: 6278820 First Time Lock Date: 16/08/2021
Version No: 1 Verification Code: 2266 Lock Date: 16/08/2021 IPAddress : 157.34.222.20

Your 10th Board Details 10th

Board Name: MP Board of
Secondary Education, Year: 2017-
2018, Roll No.: 183325918

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢šDate (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

“ȪŠ†ȡğ†ȡğȡ€ȯ]ȯ‘“•Ȩ˜[”š™Ǒ‘€¢ȡȢ€ȡͪšŽ`”›Þ’“¡ȣȲ¡Ȫ“ȯ”š ȲèȡĤ˜Ǖ†ȡğ†ȡğȡ€ȯȢ€ȧ˜Ǘ›ĤǓ
˜ȡ€[žȢŠ ȯ
‡ȡ“€ȡšȣ ×™ȡͪ”€šȯ)

Generated by Scholarship Portal as on 16/08/2021