“ȪŠ\‚š]”€Ȫ€Ȫ_ 

˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡINDORE €ȯ ]Ǒ‘ȡ Ȣͪ€ȡ žȡȡ

˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Renewal Application SC Development Department

Madhya PradeshScholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2022-23
Applicant Unique ID : 3874210
Scheme : Post Metric Scholarship for SC
Application ID: 7012470
Version No: 1 Verification Code: 9158 Lock Date: 08/12/2022 IPAddress : 103.103.214.52
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 : 166183762 Aadhaar No : XXXXXXXX9012 Voter ID : IZF1450865
Name : DEELIP CHAND RAJORIYA As per SAMAGRA: Dileep Prahlad
Gender : Male Religion : Hindu Special Category : No
Father / Husband Name PRAHLAD RAJORIYA ** Colleges / District Offices are requested to verify Board
: name,Passing year and Roll No. from student original 10th Marksheet
Mother's Name : UMA BAI
I O
Date of Birth : 26/05/2001

2.Category SC
Caste Certificate : Reg No : RS/466/0104/51078/2014, Name : DILIP KUMAR, Father Name : PRAHLAD SINGH, Mother I O
Name :UMAA BAI, Category : Scheduled Caste, Caste :Balahi
3.Academic Details Admission Date : 01/07/2019 Enrollment No. : 0831CS191024 I O
University/Board Name : Rajiv Gandhi Technical University, Bhopal
Institute : 20018-Astral Institute of Technology and Research, Indore District: INDORE
Course : 3013/B E [Full Time]/Computer Science and Engineering/4th Year
Hostel Status: Days Scholar , , Hostel Type : Day Scholar

4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2016-2017, Roll No.: 175535066

5. Last Year Exam Details : Exam Name: 3013/B E [Full Time]/Computer Science and Engineering/3rd Year, Exam Date I O
: 01/01/2022

School./Institute :Astral Institute of Technology and Research, Indore Result : Promoted to next higher Course Year
(Pass/ATKT)

6. Total Annual Family Income : Rs.35000/-

Income Certificate issued by-Revenue Department On : 08/07/2019
7 Contact Details Mobile No : 7067785686 dileeprajoriya2019[AT]gmail[DOT]com I O
Correspondance Address : Mhow, District :- INDORE

Permanent Address : Village- navalpura tehsil- harsud., District :- KHANDWA

8. Bank Account No: 2547101003730, IFS Code: CNRB0002547, CANARA BANK, SSI, INDORE, INDORE I O
9. Previous Year Sanction Order Details Application ID : 6329628
I O
Sanction Order No.: 1323302, Sanction Order Date: 08/03/2022, Sanction Amount: Rs.52600/-

Generated by Scholarship Portal as on 07/02/2023

“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡINDORE €ȯ ]Ǒ‘ȡ Ȣͪ€ȡ žȡȡ
˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Renewal Application SC Development Department

Madhya PradeshScholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2022-23
Applicant Unique ID : 3874210
Scheme : Post Metric Scholarship for SC
Application ID: 7012470
Version No: 1 Verification Code: 9158 Lock Date: 08/12/2022 IPAddress : 103.103.214.52
]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration from Student and his Parent
˜ɇDEELIP CHAND RAJORIYA s/w/o PRAHLAD RAJORIYA ƒȪŸŽȡ€šȡ€šȢ¡Ǘȱͩ€†ȡğǙǓ“Ȣ“Ȣ€šŽ€ȧh“›ȡ^“]ȯ‘“
•Ȩ˜[˜ȯ—šȣ‚_ —Ȣ‡ȡ“€ȡǐš™ɉǔ‡ ˜ȯ˜ǕəǾ” ȯ˜ȯšȡ“ȡ˜˜ȡȡͪ”ȡ€ȡ“ȡ˜10th Board €ȧ‡ȡ“€ȡšȣ€ȯ\“Ǖ ȡš‚[‡ǓĤ˜ȡŽ
”ğ€ȯ\“Ǖ ȡšͧ›Ȳ‚]’ȡš“Ȳ‚Ÿ[€ȡ”šȣ¢ȡ”ǐšŽȡ˜]™ Ȳ–Ȳ’Ȣ‡ȡ“€ȡšȣ]™Ĥ˜ȡŽ”ğ€ȯ\“Ǖ ȡš[˜ȡ“˜ȯ\ڙ™“š€Ȫ [
€Ȫ [€ȡŸ[–ɇ€ȡȯĤȯž€ȡĤ€ȡšfȲ Ȳèȡ Ȳ–Ȳ’Ȣ‡ȡ“€ȡšȣ ¡ȣfȲ ×™¡ȰfȲ”ȪŠ[›”š‘èȡȯ«€ȯǾ”˜ȯ\”›ȪŒ€ȧ‚_¡Ȱ)˜ɇ
[˜ȡ“žȰ¢ͨŽ€ ğ˜ȯ€ȯ›f€¡ȣĤ€ȡš€ȧè€Ȩ›ͧž[”€ȯͧ›f]ȯ‘“ͩ€™ȡ¡Ǘȱ)™Ǒ‘^“˜ȯ ȯ€Ȫ_—Ȣ‡ȡ“€ȡšȣ\ ×™™ȡğǕǑŠ”ǗŽ[”ȡ_
‡ȡȢ¡ȰȪ˜ȯšȡ†ȡğǙǓ]ȯ‘“•ȡ˜[ ȲèȡèȢ€ǙǓ€ȡ[\ͬ’€ȡšȣͪ—ȡ‚ƮȡšȡǓ“šèͩ€f‡ȡ“ȯ”š˜ɇ蝙‡–ȡ–‘ȡšš¡Ǘȱ‚ȡš¡Ǘȱ‚Ȣ)žȡ “
˜ȯšȯͪǽƨ¤ȡ“Ǘ“Ȣ€ȡ™[ȡ¡ȣ€š“ȯ€ȯͧ›f蝏Ȳğ¡Ȫ‚ȡ)
˜ɇ€Ȫ [”ǗŽ[¡Ȫ“ȯ€ȯ”¡›ȯ€Ȫ [ Ȳèȡ†Ȫ°‘ȯȡ‘ȯȢ¡ǗȱȪ™¡˜ȯšȣ”ǗŽ[ǔ‡à˜ȯ‘ȡšȣ¡Ȫ‚Ȣͩ€˜ȯšȯƮȡšȡ”Ǘ[˜Ʌ Ȳ–Ȳͬ’€Ȫ [€ȯͧ›™ȯĤȡƯ
†ȡğǙͪƣžȡ “€Ȫ Ȳ–Ȳͬ’ǔ‡›ȡ€ȡ™ȡ[›™€ȯ˜ȡڙ˜ ȯ…ȡ›ȡ“ ȯȡ” €š‘ǗȲ‚ȡ‘ǗȲ‚Ȣ)†ȡğǙͪƣȡ” “€š“ȯͩ€ǔèǓ˜Ʌžȡ “˜ȯšȯ
ͪǾƨ€Ȫ_—Ȣ€ȡ™ȡ[ȡ¡ȣ€š“ȯ€ȯͧ›™ȯ蝏Ȳğš¡ȯ‚ȡ)

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢šDate (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

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

Generated by Scholarship Portal as on 07/02/2023

“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡINDORE €ȯ ]Ǒ‘ȡ Ȣͪ€ȡ žȡȡ
˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Renewal Application SC Development Department

Madhya PradeshScholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2022-23
Applicant Unique ID : 3874210
Scheme : Post Metric Scholarship for SC
Application ID: 7012470
Version No: 1 Verification Code: 9158 Lock Date: 08/12/2022 IPAddress : 103.103.214.52

Previous Year MarkSheet

Fees Receipt/ Admission Slip

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢šDate (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

“ȪŠ†ȡğ†ȡğȡ€ȯ]ȯ‘“•Ȩ˜[”š™Ǒ‘€¢ȡȢ€ȡͪšŽ`”›Þ’“¡ȣȲ¡Ȫ“ȯ”š ȲèȡĤ˜Ǖ†ȡğ†ȡğȡ€ȯȢ€ȧ˜Ǘ›ĤǓ
˜ȡ€[žȢŠ ȯ
‡ȡ“€ȡšȣ ×™ȡͪ”€šȯ)
™Ǒ‘]”‚›Ø™ɉ€ȯ]’ȡš”š†ȡğǙǓ›ȯȯ¡Ǖ]”ȡf‚™ȯȪ]”€ȧ†ȡğǙͪƣǓ“šè€š‘ȣ‡ȡȯ‚Ȣȡ†ȡğǙͪƣ€ȧǔ‡“Ȣš€˜‘ȣ‚_¡Ȱ` ȯ
ȡ” ›ȯ›ȣ‡ȡȯ‚Ȣ)^ š¡€ȯͩЙȡ€›ȡ” ȯ ˜ǔےͪ’ȡȸ€Ȫ¡˜ȯžȡ€ȯͧ›fͩ€ Ȣ—Ȣ™Ȫ‡“ȡ€ȯ\ۏ‚[ͩ€ Ȣ—Ȣ†ȡğǙͪƣ ȯͪǔ‡[(Debarred)
€šǑ‘™ȡ‡ȡ™ȯ‚ȡȡͪ’ȡȸ€Ȫ€ȡ›ȣ Ǘ…Ȣ(Black List) ˜ɅŒȡ›Ǒ‘™ȡ‡ȡ™ȯ‚ȡȡ†ȡğǙͪƣèȢ€Ǚ€ȡ[\ͬ’€ȡšȣ\ȡ\ۙ ¢˜\ͬ’€ȡšȣ]æ™€
 ˜ˆȯ‚ɅȪ` €ȯͪǽڑ—ȡšȢ™‘ÖŒ ȲǑ¡ȡ€ȧ’ȡšȡjȲfȲ€ȯ¡f•]_]š‘‡[€šȡ_‡ȡ€š É€ȡ™[ȡ¡ȣ€ȧ
‡ȡȯ‚Ȣ)

Generated by Scholarship Portal as on 07/02/2023