“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ

˜Ʌ Ȳ”€[€š €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 : 3533364
Scheme : Post Metric Scholarship for OBC
Application ID: 6479559
Version No: 1 Verification Code: 1465 Lock Date: 27/12/2021 IPAddress : 117.217.80.170
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 : 142765436 Aadhaar No : XXXXXXXX0323 Voter ID : --
Name : ABHISHEK PAL As per SAMAGRA: ABHISHEK PAL
Gender : Male Religion : Hindu Special Category : No
Father / Husband Name GHASHIRAM PAL ** Colleges / District Offices are requested to verify Board
: name,Passing year and Roll No. from student original 10th Marksheet
Mother's Name : SHAKUN PAL
I O
Date of Birth : 25/09/2000

2.Category OBC
Caste Certificate : Reg No : RS/446/0106/55074/2015, Name : ABHISHEK PAL, Father Name : GHASIRAM PAL, Mother I O
Name :SAKUN PAL, Category : OBC, Caste :Gaadri
3.Academic Details Admission Date : 20/08/2021 Enrollment No. : 0105CS191007 I O
University/Board Name : Rajiv Gandhi Technical University, Bhopal
Institute : 20296-Oriental Institute of Science and Technology, Bhopal District: BHOPAL
Course : 3013/B E [Full Time]/Computer Science and Engineering/3rd Year
Hostel Status: Days Scholar , , Hostel Type : Day Scholar

4. 10th Board Details 10th Board Name: C.B.S.E. Board, Year: 2016-2017, Roll No.: 1209395

5. Last Year Exam Details : Exam Name: 3013/B E [Full Time]/Computer Science and Engineering/2nd Year, Exam Date I O
: 12/02/2020

School./Institute :Oriental Institute of Science and Technology, Bhopal Result : Promoted to next higher Course Year
(Pass/ATKT)

6. Total Annual Family Income : Rs.60000/-

Income Certificate issued by-Revenue Department On : 20/05/2019
7 Contact Details Mobile No : 7067399470 pala26877[AT]gmail[DOT]com I O
Correspondance Address : makan no 22 WARD no 03, District :- RAISEN

Permanent Address : makan no 22 WARD no 03, District :- RAISEN

8. Bank Account No: 7731000100021280, IFS Code: PUNB0527410, PUNJAB NATIONAL BANK, EC BHOPAL, RAISEN I O
ROAD, BHOPAL
9. Previous Year Sanction Order Details Application ID : 5536503
I O
Sanction Order No.: 1295128, Sanction Order Date: 10/08/2021, Sanction Amount: Rs.30225/-

Generated by Scholarship Portal as on 13/12/2022

“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ
˜Ʌ Ȳ”€[€š €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 : 3533364
Scheme : Post Metric Scholarship for OBC
Application ID: 6479559
Version No: 1 Verification Code: 1465 Lock Date: 27/12/2021 IPAddress : 117.217.80.170
]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration from Student and his Parent
˜ɇABHISHEK PAL s/w/o GHASHIRAM PAL 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 ȡš
ͧ›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 י¡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\ י™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¢š Date (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 13/12/2022

“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ
˜Ʌ Ȳ”€[€š €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 : 3533364
Scheme : Post Metric Scholarship for OBC
Application ID: 6479559
Version No: 1 Verification Code: 1465 Lock Date: 27/12/2021 IPAddress : 117.217.80.170

Previous Year MarkSheet

Fees Receipt/ Admission Slip

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢š Date (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 יȡͪ”€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 ɏ€ȡ™[ȡ¡ȣ€ȧ
‡ȡȯ‚Ȣ)

Generated by Scholarship Portal as on 13/12/2022