Government of Odisha

State Scholarship Portal

Scholarship Application Form
Application Number : 1021661 Renewal Application Scheme : Post Matric Scholarship-OBC/SEBC

Personal Details

Name : JANMEJOY PARIDA Gender : Male

RABINDRA PARIDA Mother's Name : SANTILATA PARIDA
Father's Name :
Annual Income : Rs.30000/- Date of Birth : 17/05/1997
Category : OBC / SEBC Religion : Hindu
Special Category : No ADHAAR Card No. : 7713/9309/6037
Caste Certificate 1360 & 11/09/2013 Caste Certficate TAHASILDAR NILAGIRI
No. & Date : Issued by :

Academic Details
Institute : Gandhi Institute for Education Tehsil / District : Khurda /Khordha
Technology
Course : Engineering / Mechanical Fourth Academic Year : 2017 - 18
Engineering Year
Hosteller : Yes 10th Class Details: Orissa State Board /2011 - 12
/CAB053029
Hostel Admission 17/07/2017 Last Exam 75.00
Date: Percentage:
Enrolment No. and 144064 & 05/08/2014 Admission date for 17/07/2017
Date : Academic year(2017
- 18) :

Contact Details :
Correspondence AT/PO-KANDAGARADI Permanent AT/PO-KANDAGARADI
Address PS-NILAGIRI, DISTRICT :- Baleswar Address PS-NILAGIRI, DISTRICT :- Baleswar
(Balasore) , STATE :- Odisha , PIN (Balasore) , STATE :- Odisha , PIN
CODE :- 756042 CODE :- 756042
Contact Numbers : 8280463051 Email Address : parida.papu60@gmail.

Bank Details :
IFSC Code : SBIN0007020
Bank Name : STATE BANK OF INDIA Branch Name : BALASORE IND. ESTATE, Baleswar
(Balasore)
Branch Address:
AT/P.O. - BALASORE, , PIN: 756001 Account Number : 33302726810

Declaration

Generated by Scholarship Portal as on 14/9/2017

 Government of Odisha
State Scholarship Portal
Scholarship Application Form
Application Number : 1021661 Renewal Application Scheme : Post Matric Scholarship-OBC/SEBC

I, JANMEJOY PARIDA S/o RABINDRA PARIDA hereby declare that the information given in the application form are true as per best
of my knowledge and belief. I also undertake that if, at any stage, it is found to the satisfaction of the sanctioning authority that the
information given by me is false, the entire amount of scholarship will be recovered from as arrears of land revenue or any other law in
force apart from such penal action as warranted by law. I have not applied for /in receipt of any other scholarship from Govt of
India/Govt of Orissa.

Check List
Document to be attached : -

1. Caste Certificate issued from the competent authority

2. Residential Certificate
3. Income Certificate from the concerned authorized authority/Persons
4. H.S.C Certificate (Photo Copy) Attested by Competent authority
5. Photo Copy of the first page of Bank Passbook having account no
6. Income declaration of parents/guardian from all the sources on non-judicial stamp paper
(Signature)

Generated by Scholarship Portal as on 14/9/2017