District Level Scholarship Scheme

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Google Forms <forms-receipts-noreply@google.com> Wed, 3 Jan, 2024 at 11:52 pm

To: ashu6392725730@gmail.com

Thanks for filling out District Level Scholarship Scheme

Here's what was received.

District Level Scholarship Scheme

Scholarship and Fee Reimbursement Online System

Your email (ashu6392725730@gmail.com) was recorded when you submitted this form.

Category *

OBC

SC,ST

GENERAL

Minority Caste

District
*

GONDA

BALRAMPUR

BEHRAICH
 SHRAVASTI

Educational Institution (School Name)

*

R S S rajpati sikshan sansthan

Religion
*

Hinduism

Islam

CLASS *

1 TO 5

6 TO 8

9 TO 10

11 TO 12

Student Aadhar Number *

407317693938

Date Of Birth *

MM DD YYYY

03 / 24 / 2011
Student Name As Per Aadhaar OR MARKSHEET
*

Nancy Verma

Student Whatsaap or Contact number

*

9721389427

Father Name *

Vikram Verma

Parents Whatsaap or Contact number *

9721389427

Mother Name *

Usha verma

Full Address *

Dhane Pur district gonda

Student Registration Number

*
2033

Ration Card OR Family ID NO *

No

Handicapped Person
*

YES

NO

Handicapped PERCENTAGE
*

No

Is The Student's Father Literate?

*

YES

NO

Is The Student's MOTHER Literate?

*

YES

NO
BANK NAME
*

Indian bank

BANK BRANCH IFSC CODE *

IDIB000D604

STUDENT BANK ACCOUNT NO *

59163227906

Name on Student's Bank Account

*

Usha verma

Approved Annual Nonrefundable Compulsory Fee

*

4000

Last year's result

*

PASS

Fail

PARMOTED
Integer Number Marked By Organization
*

1800

Last Year's Marks

*

1403

Name of Educational Institution

*

Shri R S Late R P Shikshan Sansthan

Caste Certificate Application No.

*

No

Caste Certificate No.

*

No

Income Certificate Application No.

*

231830020016178
Income Certificate No.
*

531232005825

Student Photo *

Submitted files

IMG-20240102-WA0001 - Ashu Verma.jpg

Student Aadhar Card Front *

Submitted files

IMG-20240102-WA0006 - Ashu Verma.jpg

Student Aadhar Card Back

*

Submitted files

IMG-20240102-WA0003 - Ashu Verma.jpg

Student Last Year Marksheet *

Submitted files

IMG-20240102-WA0005 - Ashu Verma.jpg

Bank Passbook *

Submitted files
 IMG-20240102-WA0002 - Ashu Verma.jpg

Caste Certificate
*

Submitted files

IMG-20240102-WA0004 - Ashu Verma.jpg

Income Certificate
*

Submitted files

IMG-20240102-WA0004 - Ashu Verma.jpg

Current Or Last Months Fee Slip *

Submitted files

IMG-20240102-WA0000 - Ashu Verma.jpg

Scholarship Fee Payment Rs-1

UPI ID-mystery@sbi

Account

QR CODE

UPI ID- mystery@sbi

Translation ID NO *

T2401032351020579913379

PAYMENT SCREENSHORT *

Submitted files

Screenshot_2024-01-03-23-51-23-245_com.phonepe.app - Ashu Verma.jpg

Fill Captcha Code: MEFdlss2024 *

 MEFdlss2024

Note- After filling this form, the student will have to submit the print out of this
form at the registered office of the institution or the student can also submit his
form through speed post.

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