Applicant Form

Ȫ\]ȪȪ_
èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡBHOPAL ȯ ͪ°ȡ[ãȡ

Ʌ Ȳ[ ȯ¡Ȱ)
Renewal Application Backward Classes & Minorities Welfare Dept.

Madhya PradeshScholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2021-22
Applicant Unique ID : 3986487
Scheme : Post Metric Scholarship for OBC
Application ID: 6362304
Version No: 1 Verification Code: 7768 Lock Date: 13/12/2021 IPAddress : 157.34.19.210
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.
1. Personal Details SAMAGRA ID : 122656258 Aadhaar No : XXXXXXXX7678 Voter ID : --
Name : ABHISHEK SINGH As per SAMAGRA: Abhishek Singh
Gender : Male Religion : Hindu Special Category : No
Father / Husband Name MAHENDRA SINGH ** Colleges / District Offices are requested to verify Board
: name,Passing year and Roll No. from student original 10th Marksheet
Mother's Name : ARCHANA SINGH
I O
Date of Birth : 25/01/2001
2.Category OBC
Caste Certificate : Reg No : RS/429/0118/2913/2020, Name : ABHISHEK SINGH, Father Name : MAHENDRA SINGH, I O
Mother Name :ARCHANA SINGH, Category : OBC, Caste :Kurmi
3.Academic Details Admission Date : 24/08/2021 Enrollment No. : 0101EC201009 I O
University/Board Name : Rajiv Gandhi Technical University, Bhopal
Institute : 20478-University Institute of Technology RGPV, Bhopal District: BHOPAL
Course : 3021/B E [Full Time]/Electronics and Communication Engineering/2nd Year
Hostel Status: Hosteller , Admission Date in Hostel:29/10/2021 , Hostel Type : Institute Hostel
4. 10th Board Details 10th Board Name: C.B.S.E. Board, Year: 2016-2017, Roll No.: 1264958
5. Last Year Exam Details : Exam Name: 3021/B E [Full Time]/Electronics and Communication Engineering/1st Year, I O
Exam Date : 03/07/2021
School./Institute :University Institute of Technology RGPV, Bhopal Result : Promoted to next higher Course Year
(Pass/ATKT)
6. Total Annual Family Income : Rs.281616/-

Income Certificate issued by-Revenue Department On : 26/11/2020
7 Contact Details Mobile No : 7974614502 abhishk2181[AT]gmail[DOT]com I O
Correspondance Address : Pithaurabad, District :- SATNA
Permanent Address : , Pithaurabad, District :- SATNA

8. Bank Account No: 59197207616, IFS Code: IDIB000U520, INDIAN BANK, UMARI, SATNA I O
9. Previous Year Sanction Order Details Application ID : 5473552
I O
Sanction Order No.: 1295944, Sanction Order Date: 26/08/2021, Sanction Amount: Rs.26800/-
Generated by Scholarship Portal as on 13/12/2021

Ȫ\]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡBHOPAL ȯ ͪ°ȡ[ãȡ
Ʌ Ȳ[ ȯ¡Ȱ)

]ȯfȲȡȧȪȡDeclaration from Student and his Parent
ɇABHISHEK SINGH s/w/o MAHENDRA SINGH ȪȡȡȢ¡ǗȱͩȡğǙǓȢȢȧhȡ^]ȯȨ[ȯȣ
_ Ȣȡȡǐɉǔ ȯǕÉǾ ȯȯȡȡȡȡͪȡȡȡ10th Board ȧȡȡȣȯ\Ǖ ȡ[ǓĤȡğȯ
\Ǖ ȡͧȲ]ȡȲ[ȡȣ¢ȡǐȡ] ȲȲȢȡȡȣ]Ĥȡğȯ\Ǖ ȡ[ȡȯ\ÚȪ [Ȫ [ȡ
[ɇȡȯĤȯȡĤȡfȲ Ȳèȡ ȲȲȢȡȡȣ ¡ȣfȲ ×¡ȰfȲȪ[èȡȯ«ȯǾȯ\Ȫȧ_¡Ȱ)ɇ[ȡ
Ȱ¢ͨ ğȯȯf¡ȣĤȡȧèȨͧ[ȯͧf]ȯͩȡ¡Ǘȱ)Ǒ^ȯ ȯȪ_Ȣȡȡȣ\ ×ȡğǕǑǗ[ȡ_ȡȢ¡ȰȪ
ȯȡȡğǙǓ]ȯȡ[ ȲèȡèȢǙǓȡ[\ͬȡȣͪȡƮȡȡǓèͩfȡȯɇèȡȡ¡Ǘȱȡ¡ǗȱȢ)ȡ ȯȯͪǽƨ
¤ȡǗȢȡ[ȡ¡ȣȯȯͧfèȲğ¡Ȫȡ)
ɇȪ [Ǘ[¡Ȫȯȯ¡ȯȪ [ ȲèȡȪ°ȯȡȯȢ¡ǗȱȪ¡ȯȣǗ[ǔàȯȡȣ¡ȪȢͩȯȯƮȡȡǗ[Ʌ ȲȲͬȪ [ȯͧȯĤȡƯ
ȡğǙͪƣȡ Ȫ ȲȲͬǔȡȡȡ[ȯȡÚ ȯȡȡ ȯȡ ǗȲȡǗȲȢ)ȡğǙͪƣȡ ȯͩǔèǓɅȡ ȯȯ
ͪǾƨȪ_Ȣȡȡ[ȡ¡ȣȯȯͧȯèȲğ¡ȯȡ)
(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢
Declaration from Institute Head & Institute Scholarship Nodal Officer

We, hereby, certify that student is enrolled in college in the course approved/recognized by concerned board/council/university. All details filled
by student in above application form have been verified with original documents & have been found to be correct / authentic. Applicant has
promoted to next higher course year(Pass/ATKT). College has ORIGINAL COPY of his Transfer Certificate. Applicant is not enrolled in another
institute. Applicant's attendance is regular.
We have verified all details as per scheme guidlelines & 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 it on portal and
to 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 legal and penal action against the institute.
(Signature ) (Signature ) Date (Signature )

Scholarship Nodal Officer HOD Director/Prinicpal
Income Certificate Details

Ȫ\]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡBHOPAL ȯ ͪ°ȡ[ãȡ
Ʌ Ȳ[ ȯ¡Ȱ)

Previous Year MarkSheet
Fees Receipt/ Admission Slip
(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢
Ȫȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)
Ǒ]Øɉȯ]ȡȡğǙǓȯȯ¡Ǖ]ȡfȯȪ]ȧȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢȣ_¡Ȱ` ȯ
ȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢȡğǙͪƣ ȯͪǔ[(Debarred)
ǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ(Black List) ɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[\ͬȡȣ\ȡ\Û ¢\ͬȡȣ]æ
ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲȯ¡f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧ
ȡȯȢ)

Applicant Form

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Applicant Form

Uploaded by

Copyright:

Available Formats

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡBHOPAL ȯ ͪ°ȡ[ãȡ

Renewal Application Backward Classes & Minorities Welfare Dept.

6. Total Annual Family Income : Rs.281616/-

Permanent Address : , Pithaurabad, District :- SATNA

Generated by Scholarship Portal as on 13/12/2021

Renewal Application Backward Classes & Minorities Welfare Dept.

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

Declaration from Institute Head & Institute Scholarship Nodal Officer

(Signature ) (Signature ) Date (Signature )

Income Certificate Details

Generated by Scholarship Portal as on 13/12/2021

Renewal Application Backward Classes & Minorities Welfare Dept.

Previous Year MarkSheet

Fees Receipt/ Admission Slip

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

Generated by Scholarship Portal as on 13/12/2021

You might also like

Applicant Form

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Applicant Form

Uploaded by

Copyright:

Available Formats

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡBHOPAL ȯ ͪ°ȡ[ãȡ

Renewal Application Backward Classes & Minorities Welfare Dept.

6. Total Annual Family Income : Rs.281616/-

Permanent Address : , Pithaurabad, District :- SATNA

Generated by Scholarship Portal as on 13/12/2021

Renewal Application Backward Classes & Minorities Welfare Dept.

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

Declaration from Institute Head & Institute Scholarship Nodal Officer

(Signature ) (Signature ) Date (Signature )

Income Certificate Details

Generated by Scholarship Portal as on 13/12/2021

Renewal Application Backward Classes & Minorities Welfare Dept.

Previous Year MarkSheet

Fees Receipt/ Admission Slip

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

Generated by Scholarship Portal as on 13/12/2021

You might also like

Ȫ\]ȪȪ_

èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡBHOPAL ȯ ͪ°ȡ[ãȡ

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

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