GOVERNMENT OF GUJARAT (BCK-6.1) Post Matric Scholarship for SC students (Government of India Scheme) Renewal Application Previous Application No: 212200000000373371 Previous Paid Scholarship: Student Basic Details ‘Name of Studen BAROT DEV SURESHEHA Name of Student (As per Aadhar) : DEV SURESHBHAI BAROT Mother's Name : DAXABEN Date of Birth : 20/0/2002 Category : scrucyRa mA) Caste: Hinds Mabyaven Gog migracel d ‘Aadhaar Status Verified: Yex6/102022 1:55.00) Annual Income of Parents/Guardian/Husband (Rs 150000 Mol ile Number : 7698826718 Aadhar No : xcaseso025 Is Orphan: No ‘Submit Date: 14/10:2022 pepleaton No Gender : Mate Religion :tindu ‘Habitation Type: Rural E-mail Address: devbualipre84aigmaisom Parent/Guardian oceupation: Labour) Day Scholar / Hosteller ; Day Scholar Marital Status : Unmaries Hostel Type: Current Address: Permanant Address: State art State art District Newt District News Taluka Cait Taluka Ca Village Alper Village Alper PinCode 396400 PinCode 396400 Addrers:ALIPORE MAHYAVANSHI MAHOLLO JAIN MANDIR Addrets:ALIPORE MAHYAVANSHI MAHOLLO JAIN CHIKHLT MANDIR CHIKHLT judent Bank -ount Det: /Aadhar Bank Deta Zivotuarty gve my consent o use my Aadhar detail Aadhar Number: S8xx30%%9925 Mandate Date : 8/21/2015 12:00:00 AM Bank name : XXXX Bank Status: Active (A iam giving my consent for peyment of scholarship amount in any bak account, inked with Andbar. ‘Account No : O2xxxxxx0587 Student Name(As per Bank Name): DEV SURESHBHAl BARO? [Name of Bank : BANK OF 8ARODA [Branch Name & Address : ALIPORE, DIST, NAVSARI, GUIARAT ery a v ‘Details provided by me are correct to best of my knowledge IFSC Code: BARBOALIPOR 2Shallaet make clin mounts alerted oa ong account di incorrectas provided by me 5 Shall refund the amount ante to someon l'auto neo desis proved ye Student Academic Details Present Course/Class/Trade Type: Engiesng& Technology Present Course/Class/Trade Name : Di Diploms Engineering) Present Course/Class/Trade Year : 38D YEAR(Sts Semesterth Semester) ‘Courtesy : National Informatics Centre, Gujarat Page 1 of 3 222300000000206535 Print Dato :14/1012022Studying in = Gujarat Present Institute District : The Dangs ‘Admission Type : Regular Sea(Goversmert Qua) Enter Your Rescarch/Thesis Subject Present Class Start Date: it ub2022 Fees ‘Admission Fees (Rs) Tutlon Fees (Rs) Mise-Fee(NonRefundable Fees) Exam Fees(Rs) Total (Rs) Previous stream :DF (Diploma Engineering) Previous Passing Year :2021 Educational Break : No Previous Education Detail Course/Class/Trade Type Disablity Detail Is Disability : No Percentage of disability: - (Guide Nam Guide Address: - List of documents which you have attached : 2 Foe Resspt of Cent Curse Year 4 some Crist (Competent Authority For 16 egied For Govt, 5 St: Mlaet 6 School Leaving Cetcate Ary) 7 Su:12 Maisheet Any) Went Car Coege'Sehot (Course/Class/Trade Name DE Diploma Enginesring) nrolient No: 206168307025 Present Institute : Goverment Polytecaie Aahvs-Duee 616 Present Branch Course : Compute Enginring Present Course Completion Date : 15-Jun-2023 Amount 4 Previous Class/Course : 2ND YEAR(ni Semester Semesen Previous (%): 7.76 No. Of. Year in Break : Branch Name [Seat No Passing Year Percentage COMPUTER 2616030 202 a8 ENGINEERING 7025 Type of Disability : Required Guide/Coaching Guide: No have read all above terms and conditions and understand them fully, I hereby declared that here Iam submitting only one application for scholarship and I haven’t received any other scholarshipistipend or fellowship inthis current session under any other ‘central/state government scheme. I futher state that all information furnished by me is correct to my knowledge in case of any the false information or suppression of necessary data proved in my application is liable to get cancelled at any stage of the scholarship process and the entire amount of scholarship will be refunded by me or recovered from me. Government decision shall be final aad binding on me, Date : 14/10/2022 ‘Verify Mobile Number : Yes 14/10/2022 Place: Signature ofthe applicant ‘Courtesy : National Informatics Centre, Gujarat Page 20f3 222300000000206535 Print Dato :14/1012022Iti certified thatthe information filled in the above mentioned fields by the students are correct to the best of my knowledge and all the Documents has been checked. Iti also certified that in case the applicant leaves institution or otherwise discontinues the studies or detained or accepts any other regular scholarships/stipend’ fellowship the fact will be immediately reported tothe said authority Certified that the student is eligible for scholarship amount subject to Ceatral/State government rules and the student is recommended for sanction of scholarship, This isto certify that student has regularly attended classes and maintained minimum attendance criteria till date for the A.Y. 2022 = 2023.1¢ student will ireglar, than we will immediately reported to the said authority The actual School/College/University year began on and will be ended on, Signature Of Head Of The SchoolColegefastiuteUniversty With Offa Seal ‘Courtesy : National Informatics Centre, Gujarat Page 3of3 222300000000206535 Pri Dato :14/1012022