12/30/23, 6:41 PM STSC92401013718366

Scholarship Application Form

ST&SC and MBC Welfare Department
Academic Year 2023-24
STSC92401013718366
Government of Odisha

Basic Information

Department Scheme Academic Year Application Type

ST&SC and MBC Welfare Post Matric Scholarship 2023-24 Renew in New Course
Department

Applicant Details

Applicant Name Category Applicant Gender

Sneha Maharana OBC/SEBC Female

Religion Date of Birth Aadhaar No.

Hindu 24 Aug 2005 (18 Year) XXXXXXXX2716
 Applicant's Aadhaar is seeded with his/her Bank Account and status is Active.

Mobile No. Alternative Mobile No. e-Mail Id

7064251925 8480541043 joshnamaharana377@gmail.com

Father's Name Father Educational Status Father Occupational Status

Narasingha Maharana Literate Daily Wage Earner

Mother's Name Mother Educational Status Mother Occupational Status

Joshna Maharana Literate House Wife

Guardian Name Individual/ Family Information

VIEW
Narasingha Maharana Beneficiary of NFSA

Address Information

District Block/ULB GP/Ward

Ganjam Berhampur Mc Brahmapur (M Corp.) - Ward No.22

Pin Code Address

760001 Baikuntha Nagar 3rd line , Berhampur ,
Berhampur

Educational Qualification Details

For : Matric-Annual

Passing Total Secured Percentage Marksheet/

Course Board Roll No. Year Mark/CGPA Marks/CGPA (%) Certificate

X BSE, Odisha 081DB0300 2021 600 433 72.17 Uploaded

Plus 2 CHSE, 247EA065 2023 600 423 70.50 Uploaded

Odisha

Institute / Course Information (Current Education Information)

Institute Type
Govt.

Institute District Block/ULB

Sashi Bhusan Rath Government Women's Ganjam Berhampur Mc
Higher Secondary School, Berhampur
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Nature of Course Course Branch/Stream/Trade

General Plus 2 Commerce

Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date

2nd Year EA47C21068 15 Sep 2021

Enrollment No. Enrollment Date

231 15 Sep 2021

Any Exam Conducted during current academic year? : No

Residential Status

Whether
Day Scholar

Details of Last Exam Passed

Course Course Year Passing Year

Plus 2 2nd Year 2023

Total Mark/CGPA Secured Marks/CGPA Percentage (%)

600 423 70.5

Certificate
Uploaded

Eligibility Information

Income Certificate No. Family Income (in Rs.) To Whom the Certificate Issued
E-INC/2023/547791   60000.00 Revenue Officers not below the rank of
Tahasildar

Issuing Authority Issue Date Income Certificate

Revenue Officers not below the rank of 26 May 2023 Uploaded
Tahasildar / Additional Tahasildar

Matriculation Certificate No. Issuing Authority Matriculation Certificate

211243447 BSE, Odisha (Annual) Uploaded

Caste Certificate No. To Whom the Certificate Issued Issuing Authority

E-OBC/2023/572158  Revenue Officers not below the rank of Revenue Officers not below the rank of
Tahasildar Tahasildar / Additional Tahasildar

Issue Date Caste Certificate

25 Dec 2023 Uploaded

Institute Declaration Certificate

NA

Bank Information

Account Holder Name IFSC Code Account No.

SNEHA MAHARANA SBIN0012105 38548877556

Whether account number tagged /seeded with

the Aadhaar number?
Yes

Bank Name Branch Name

STATE BANK OF INDIA LOCHHAPADA

Passbook front page

Uploaded

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Student Declaration

1. I have read and understood the conditions of award of Scholarship.

2. I am aware that my application is liable to be rejected, if it is found at any stage, that Aadhaar number provided by me is wrong or Aadhaar number is of
someone’s else.
3. I am aware that if more than one application is found, all my applications are liable to be rejected.
4. I am aware that for any wrong entry or mis-match of the Bank-account details, the State Government will not be responsible for mis-credit and I will be
held responsible for diversion of public money on this ground.

Date ........................

Place ........................ Full Signature of Applicant

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