SCHOLARSHIP FOR HIGHER EDUCATION APPLICATION FORM

Application Status: Submitted

Advertisement No: SHE- 2019
Application Ref. #: DST/INSPIRE/02/2019/009708
IVR No: 201900039103

Personal Particulars
Salutation: Mr.

First Name: Islamudden Middle Name: Last Name:

Date Of Birth: 11/16/2001 Gender: Male Father's Name/Male Guardian

Name: Sultan khan

Mother's Name/Female Guardian Name: farjana

10th Class Certificate or Marksheet as Proof of Date of Birth: Attached Place of Birth: Rural
Below

Email Address: islamuddenkhan2001@gmail.com

Social Community: OBC

Differently Abled: No Other:

Enrollment Information (B.Sc. / Integrated M.Sc. Level)

Program Enrolled: B.Sc.

Course Enrolled: Chemistry, Maths, Physics

Enrollment/Admission Year: 2019 Admission No:

State (In which college is located): RAJASTHAN

University Type: University University Name: Jai Naraim Vyas University

University Address:Jodhpur ,Pincode:342001

College Name: Jai Narayan Vyas University, Jodhpur

District (In which college is located): Jodhpur

Endorsement Certificate: Attached Below

Senior Secondary Performance Information (12th Standard)

Name of the Board: Board of Secondary Education, Rajasthan

Passing Year: 2019 Rank in Class 12th: Board Roll Number: 2647692

Eligibility Note: Attached Below 12th Marksheet: Attached Below

Marks Information

12/04/2022 11:42 Page 1/3

Subjects Marks Obtained Maximum Marks Grade

HINDI 90 100

ENGLISH 96 100

PHYSICS 97 100

CHEMISTRY 83 100

MATHEMATICS 90 100

Total Marks Obtained: 456 Maximum Marks: 500 Overall Percentage(%): 91.2

School Name: ADITYA PUBLIC SR SEC SCHOOL

School Address: JHALAMAND CHOURAHA, JODHPUR

State (In which school is located): RAJASTHAN

District (In which school is located): Jodhpur

PinCode: 342005

National Level Competitive Examinations

Rank
Examination Year Rank
Certificate/Certificate

Other Details
Year of Passing Class X:2017 Parents Annual Income: 180000

Have you attended INSPIRE If Yes, please provide details. N/A

Science Camps:No

Contact Information
Permanent Address
Address: 4 ga 26 madhuban housing board, basni, jodhpur

Town/City: Jodhpur State: RAJASTHAN Pincode: 342005

Telephone Number (with STD Mobile Number: 7742790710

code): N/A

Communication Address
Address: 4 ga 26 madhuban housing board, basni, jodhpur

Town/City: Jodhpur State: RAJASTHAN Pincode: 342005

Telephone Number (with STD Mobile Number: 7742790710

code): N/A

Are you availing any other scholarships: N/A

12/04/2022 11:42 Page 2/3

Identification Proof : Aadhaar Card No :
Aadhaar Card XXXX XXXX 7545

Declaration: It is certified that all particulars given by me in columns above are true to the best of my
knowledge. If any particulars are found false, I am aware that my application for scholarship are liable for
cancellation.

Place: JODHPUR Submitted Date: 11/23/2019 State: RAJASTHAN

12/04/2022 11:42 Page 3/3

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 JAI NARAIN VYAS UNIVERSITY, JODHPUR
B.SC PART I EXAMINATION 2020 (REGULAR)
PROVISIONAL CERTIFICATTE

CANDIDATE'S NAME ISLAMUDDEN ROLL NO. 20BSC60569

FATHER's NAME SULTAN KHAN ENROL. No. 19R/04403

MOTHER'S NAME FARJANA

SUBJECT
CODE
SUBJECT REMARKS

cOMPULSORY SUBJECTS

SUOO01084 GENERAL HINDI

SUO001085 ENVIRONMENT STUDIES

faaTs 06.08.2020 à fad aujarrHR 3IA
OPTIONAL SUBJECTs

SUO001086 CHEMISTRY TH

PR

SUOO01089 PHYSICS TH

PR

SUO001091 MATHEMATICS

JODHPUR

DATE 16/09/2020
College of Study (003) FACULTY OF SCIENCE

veriied
This is computer generated marksheet, doesn't require signature.

Section Oficer (Exam.)

9Ma Narain Vjas University
Jodhpur
 Jai Narain Vyas University, Jodhpur

E-PAYMENT RECEIPT

Submitted Date:27/06/2020 Last Date :01/07/2020 Print Date & Time 27/06/2020 20:15:45

Roll No. 20BSC60569

Name ISLAMUDDEN
Father's Name SULTAN KHAN
Mother's Name -
FARJANA
Degree B.SC IInd Year
Previous Paid Amount 0.00
Paid Amount 1830.00
Refund Amount 0.00
Transaction ID/ Demand Draft No. CF_0000128461
Payment Date 27/06/2020 20:10:58
Mobile No. 77427907 10

ISLAMUDDEN hereby declare that Ihave made online paymentfor the online Registration fees, for which
details are mentioned above. If at any point of time it is found thatthe receipt is fake or amount is not credited n
University Account my Registration form Will be rejecled

Date 27/06/2020 Signature

Note 54T E-Payment THg at prip TT form T HHSTtA
 Department of Science and Technology
[INSPIREProgram]

Performance ReportiCertificate from the Principal of the CollegeDirector or Registrar

oftheInstitute or University for continuation of the INSPIRE Scholarship

INSPIRE Registration No: DST.LINSPIRE/02/20 19/009 708

It is certified that Mr/Ms ....ISLAMUDDEN.C 208L 6CSKI).

son/daughter of.S.ULTAN..KHAN.. '''''''
.is an INSPIRE Scholar of
' ' * ' ' ' ' ***'**

fecaltyof SieneJatWasajah lyaes lnuiessi,JedhplukasiheColleselUn

and his/her performance is Satisfactory or Not satisfactory (strike-off whichever is not applicable)

in the First /Secded /Third year of B.Sc./ntegrated-MA-SeM-S-or Firstyear of M.Sc. for continuation of

INSPIRE Scholarship. (strike-off whichever is not applicable)

I recommend that his/ber INSPIRE Scholarship may be Continued or Discontinued in the

year 2020to 20
It is also certified that the student is NOT receiving scholarship from any source other than the
Depart1nent of Science and Technology, Government of lndia.

DEAN
FACULTY OF SCLENCE
Signature with Rubbrd stáiip it HioITY
JODHPUR
(Principal of the College/Director or Registrar of the Institute or University)

Place...AHALR.. ****************

Date..09..22022

Note: Attach self-attested copy of Marks-Sheet of the Annual/Semester exanmination of B.Sc. /Int. M.Sc.
or M.Sc. course.