Directorate of Secondary Education, Assam

Kahlipara, Guwahati-19

(Submission of Bank Account Details of Candidates who have passed

HSLC Exam-2023 securing Star/Distinction Marks) Application for Cash Award

ARN : 09/UP/0802/165903/21

To,
The Secretary to the Government of Assam Department of School Education, Government of
Assam
Kindly accept my application for providing Government Support for the purchase of
laptop/computer for felicitating my study through online media.
My bank account details are provided along with the first page of Bank Passbook containing
Photograph and other details as mentioned below.

Roll Number B23-0261-0461

Name KOUSTABH BORUAH

Father's Name DIGANTA BORUAH

Mother's Name MALABIKA BORUAH

Date of Birth 02-03-2007

School Name SALT BROOK SCHOOL, DIBRUGARH

Account Number 7514803890

IFSC CODE IDIB000L509

Bank Name INDIAN BANK

Branch LAHOAL

Candidate's Mobile 8822490125

Parent/Guardian Mobile Number 7002929191

Candidate's Email kaustavboruah7@gmail.com

LAHOAL PATRA GAON NEAR BLOCK SARI ALI P.O LAHOAL PIN
Candidate's Address
786010

District 11-DIBRUGARH

Application Form Submission date 17/06/2023 19:11:54

Print Date 28/11/2023 15:43:51

Declaration : I declare that the entries in the Online Application Form have been filled up and the
entries made are correct
as per my documents and to the best of my knowledge and belief.