Department of Technical Education & Skill Development

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Department of Technical Education & Skill Development

Madhya Pradesh Scholarship Portal 2.0
Fresh Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2021-22
Applicant Unique ID: 4379419 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10403013
First Time Lock Date: 19/01/2022
Version No: 2 Verification Code: 4193 Lock Date: 19/02/2022 IPAddress : 106.76.72.100
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 : [51012],NLIU, National Law Institute University, Bhopal District: BHOPAL Course : B.A.LL.B(Hons.)(NLIU)/B.A.LL.B (Hons.)/1st
Year [5501]
Details Application Form Name of Entrance Examination : CLAT

Name AKSHAY PATHAK Roll No of Entrance Examination : 138011347
Father Name SANDEEPPATHAK Common Rank in(JEE main/NEFT/CLAT) : 177
DOB 20/01/2003 12th Percentage : 87.00
Gender Male #Ǖǽ% 12th Passing Year : 2019-2020
Category GENERAL # ȡȡÛ%
Religion : Hindu Special Category : No I O

Aadhar No. : XXXXXXXX5157
2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O
3.Academic Details As Reported by Student : Enrollment No. : 2021BALLB137 Admission Date :12/10/2021 I O
Details As Reported by Student

Admission Mode Centralized Counselling
Institute [51012],NLIU, National Law Institute University, Bhopal District: BHOPAL
Course B.A.LL.B(Hons.)(NLIU)/B.A.LL.B (Hons.)/1st Year [5501]
Academic Year 2021-22

I O
Hostel Admission Non-Hosteler(Day-Scholar)
4. Total Annual Family Income : Rs.490643/-

Father/ Husband Occupation : State Govt., Income: 490643/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
5. Contact Details Mobile No : 6263895725 ACCHE[DOT]AKSHYA[AT]GMAIL[DOT]COM I O

Correspondence Address : WARD NO.14 ATTA CHOWK UDAIPURA, District :- RAISEN
Permanent Address : WARD NO.14 ATTA CHOWK UDAIPURA, District :- RAISEN
6. Bank Account No: , IFS Code: , , , I O
7. Annual Fees Claimed(Rs.) 190500/- I O
8. Additional Scholarships Amount Claimed by the Student :

8.1 MMVY BENEFIT amount already PAID for the academic year : Rs. /-on date: I O
Additional Scholarship Amount Claimed for this acadmic year 2021-22 : Rs.190500/-
Justification for Additional claim as provided by student:
Generated by MP Scholarship Portal as on 19/02/2022

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Department of Technical Education & Skill Development

Madhya Pradesh Scholarship Portal 2.0
Fresh Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2021-22
Applicant Unique ID: 4379419 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10403013
First Time Lock Date: 19/01/2022
Version No: 2 Verification Code: 4193 Lock Date: 19/02/2022 IPAddress : 106.76.72.100
]ȯfȲȡȧȪȡDeclaration From Student and his Parent
We, AKSHAY PATHAK S/o SANDEEPPATHAK and SANDEEPPATHAK hereby declare that 12th Board Roll No, Board Name, Board Year,
Aadhaar No, SAMAGRA ID, Entrance Exam Roll No, Rank, Marks, Domicile, Annual Income and occupation details of father and Mother,
Bank account details, Amount Claimed, Hostel Status, College detils, Course Details, Category and all other information given in the application
form is complete and correct. We have not submitted any other application for Mukhyamantri Medhavi Vidharthi Yojna or any other scheme that offer
the reimbursement of fee for current academic year in any other institution. 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 Director, Technical Education Dept, Government of Madhya Pradesh will be free to
register FIR and initiate legal penal action and against us.
¡AKSHAY PATHAK S/o SANDEEPPATHAK kSANDEEPPATHAK Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[

ȣ¢ȡȡ\ǕĐȡȲ]ȡȲĤǓȪȢȣ¢ȡ\ǕĐȡȲɅ\ȲǗǓȡ Ȣȡͪ[]ɇ\ȡ`Ȳȡ\ÛͪǗ[fȲ
¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯǕÉȲğȢȯȡȢͪÚȡȸȪȡfȲ\Ûͩ Ȣ\ÛȪȡȯ\Ȳ[ͩ Ȣ\Û ȲèȡɅ
]ȯĤèǕ¡ȣȲͩȡ¡Ȱ@\`ȪƠȡȡȣͩ ȢȢèȡ_ȡȢ¡ȰȪ ȲǗ[ȡͧȡͪ ȣȡȯȢfȲ¡ȡȯͨȡ
ȡǗȢȡ[ȡ¡ȣȧȡȯȢ@
Ǒ¡Øɉȡȡȣȯ]ȡȡğǙǓȯȯ¡ǕȯȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢ
ȣ_¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ Ȣ
ȢȡğǙͪƣ ȯͪǔ[
ȢȡǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ
ÞȰͧèɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[
\ͬȡȣ\ȡ\Û ¢\ͬȡȣ]æ ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲ
ȯ¡f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧȡȯȢ)
Date (Signature of Parent / ȡͪȡȯ¡èȡ¢(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/She is eligible for sanction of
scholarship. College has ORIGINAL COPY of his School Leaving Certificate. He is attending regular Classes, as per the instructions of Government
We have verified all details as per the scheme guidelines & 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
Director, Technical Education so that his scholarship can be put on hold. In case any information 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.
Date (Signature ) (Signature ) (Signature )

MMVY Scheme Incharge HOD Director/Principal
Ȫȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)
Generated by MP Scholarship Portal as on 19/02/2022

Department of Technical Education & Skill Development

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Department of Technical Education & Skill Development

Applicant Unique ID: 4379419 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Details Application Form Name of Entrance Examination : CLAT

Religion : Hindu Special Category : No I O

2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O

Details As Reported by Student

Institute [51012],NLIU, National Law Institute University, Bhopal District: BHOPAL

Course B.A.LL.B(Hons.)(NLIU)/B.A.LL.B (Hons.)/1st Year [5501]

Academic Year 2021-22

4. Total Annual Family Income : Rs.490643/-

5. Contact Details Mobile No : 6263895725 ACCHE[DOT]AKSHYA[AT]GMAIL[DOT]COM I O

Permanent Address : WARD NO.14 ATTA CHOWK UDAIPURA, District :- RAISEN

6. Bank Account No: , IFS Code: , , , I O

7. Annual Fees Claimed(Rs.) 190500/- I O

8. Additional Scholarships Amount Claimed by the Student :

Generated by MP Scholarship Portal as on 19/02/2022

Department of Technical Education & Skill Development

Applicant Unique ID: 4379419 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

¡AKSHAY PATHAK S/o SANDEEPPATHAK kSANDEEPPATHAK Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[

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

Declaration from Institute Head & Institute Scholarship Nodal Officer

Date (Signature ) (Signature ) (Signature )

Generated by MP Scholarship Portal as on 19/02/2022

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¡AKSHAY PATHAK S/o SANDEEPPATHAK kSANDEEPPATHAK Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[

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