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Backward Classes & Minorities Welfare Dept.: Fresh Application

This document is an application form for a post-metric scholarship for OBC students in Madhya Pradesh for the year 2016-17. It contains details about the applicant such as name, father's name, date of birth, gender, category, contact details, academic details, income details, bank account details, previous scholarship details if any, and declarations signed by the applicant and parent. The applicant is providing all information required for processing the scholarship application accurately and completely.

Uploaded by

Akash Badonia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
140 views

Backward Classes & Minorities Welfare Dept.: Fresh Application

This document is an application form for a post-metric scholarship for OBC students in Madhya Pradesh for the year 2016-17. It contains details about the applicant such as name, father's name, date of birth, gender, category, contact details, academic details, income details, bank account details, previous scholarship details if any, and declarations signed by the applicant and parent. The applicant is providing all information required for processing the scholarship application accurately and completely.

Uploaded by

Akash Badonia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡVIDISHA €ȯ ͪ”†°ȡ‚[€ã™ȡŽ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application Backward Classes & Minorities Welfare Dept.


Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2016-17
Applicant Unique ID: 2260711 Scheme : Post Metric Scholarship for OBC
Application ID: 1902761 First Time Lock Date: 19/10/2016
Version No: 1 Verification Code: 6614 Lock Date: 19/10/2016 IPAddress : 14.139.232.8
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.
Institute : [20379],Samrat Ashok Technological Institute (Degree), Vidisha District: Course : B E [Full Time]/Mechanical Engineering/1st
VIDISHA Year [3031]

Old Scholarship Details(Before 2014-15 No Post Metric Scholarship was sanctioned Last Year.

Details Application Form 10th Board Data Samagra Data Counselling Data
Name AKASH BADONIA AKASH BADONIA AKASH BADONIA

Father Name MAHESH MAHESH BADONIA

DOB 29/11/1997 01/01/2002 29/11/1997

Gender Male #”ǕǽŸ% Male #”ǕǽŸ% MALE #”ǕǽŸ%

Category OBC #\ͪ”% OBC #\ͪ”% OBC #\ͪ”%

Religion : Hindu Special Category : No Voter ID : -- I O


Aadhar No. : XXXXXXXX7531

2. Details As Per Digital Caste Certificate : Reg No: RS/427/0118/6720/2019, Name : akash badonia, Father Name : I O
mahesh badonia, Mother Name : suman badonia, Category : OBC, Caste : Sunar

3.Academic Details As Repoted by Student : Enrollment No. : 0108ME161003 Admission Date :22/07/2016 I O

Details As Repoted by Student Counselling Details


Admission Mode Centralized Counselling

Institute [20379],Samrat Ashok Technological Institute (Degree), Samrat Ashok Technological Institute Vidisha (1960
Vidisha District: VIDISHA
Course B E [Full Time]/Mechanical Engineering/1st Year Mechanical Engineering
[3031]
Academic Year 2016-17 2016-17

Hostel Admission Non-Hosteler(Day-Scholar) --

Last Year Exam Details : Exam Name: HIGHER SECONDARY, Exam Date : 21/05/2016
I O
School./Institute :BHEL VIKRAM H S SCHOOL BHOPAL Result : PASS
School Scholarship Details Generated From Samagra Portal
Name : AKASH BADONIA Category : OBC DOB : XXXXXX2002 Gender : Male
Father Name : --- BPL : “¡ȣȲ CWSN : No

Sno Academic Year School Current Class


1 2014-15 BHEL VIKRAM HIGHER SECONDARY SCHOOL 12 th

4. 10th Board Details 10th Board Name: C.B.S.E. Board, Year: 2013-14, Roll No.: 1178707 I O

5. Total Annual Family Income : Rs.72000/- Income Certificate : issued by-REVENUE DEPARTMENT ON : 30/06/2016
Father/ Husband Occupation : Own Business/Shop, Income: 72000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-

6. Contact Details Mobile No : 7240866017 AKASHBADONIA99[AT]GMAIL[DOT]COM I O

Generated by Scholarship Portal as on 02/11/2019


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

Fresh Application Backward Classes & Minorities Welfare Dept.


Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2016-17
Applicant Unique ID: 2260711 Scheme : Post Metric Scholarship for OBC
Application ID: 1902761 First Time Lock Date: 19/10/2016
Version No: 1 Verification Code: 6614 Lock Date: 19/10/2016 IPAddress : 14.139.232.8
Correspondance Address : 110 SEC B INDRAPURI BHOPAL, District :- BHOPAL

Permanent Address : 263 KANASAIYA KOKTA, District :- BHOPAL


7. Bank Account No: 20367509759, IFS Code: SBIN0012193, STATE BANK OF INDIA, SATI VIDISHA, VIDISHA I O
8. Change History NIL I O
ALERT: Details of Applications already registered by using same Samagra ID :
Applicant Unique ID: 2260711, Application ID: 2494911, Applicant Name: AKASH BADONIA, DOB:29/11/1997, Father
Name:MAHESH, Gender:Male, Category:OBC, Mobile:7240866017, Institue:Samrat Ashok Technological Institute
(Degree), Vidisha, Branch:Mechanical Engineering, Year:Second Year, Application Date:07/10/2017, Applicant Unique ID:
2260711, Application ID: 3602213, Applicant Name: AKASH BADONIA, DOB:29/11/1997, Father Name:MAHESH,
Gender:Male, Category:OBC, Mobile:7240866017, Institue:Samrat Ashok Technological Institute (Degree), Vidisha,
Branch:Mechanical Engineering, Year:Third Year, Application Date:05/10/2018, Applicant Unique ID: 2260711,
Application ID: 4453680, Applicant Name: AKASH BADONIA, DOB:29/11/1997, Father Name:MAHESH, Gender:Male,
Category:OBC, Mobile:7240866017, Institue:Samrat Ashok Technological Institute (Degree), Vidisha, Branch:Mechanical
Engineering, Year:Fourth Year, Application Date:23/10/2019
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil

]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration From Student and his Parent


1. We, AKASH BADONIA S/o MAHESH and MAHESH hereby declare that Board Roll No, Samagra ID, caste certificate and income certificate,
bank account details and all other information given in the application form is complete and correct. We have not submitted any other application for
scholarship for current academic year in any other institution in India. We also undertake that, if any information given above is found to be false at any
stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal action against us.
¡˜AKASH BADONIA S/o MAHESH kšMAHESH ƒȪŸŽȡ€šȯ¡ɇͩ€`”šȪƠ‡ȡ“€ȡšȣ ¡ȣ¡ȰfȲ ˜Ē]_ŒȢ€¢ȡCB–ȪŒ[
”šȣ¢ȡ€ȧ˜ȡ€[žȢЇȡǓȡ]™Ĥ˜ȡŽ”ğ–ɇ€\€ȡ`ȲŠȡ\ۙͪšŽ”ǗŽ[fȲ ¡ȣ¡Ȱ@]ȯ‘€“ȯ”ȪŠ[›”š^  ğ˜ȯè€Ȫ›šͧž”
€ȯͧ›f€ȯ›f€¡ȣ]ȯ‘“ͩ€™ȡ¡Ȱ@\‚š`”šȪƠ‡ȡ“€ȡšȣ‚›”ȡ_‡ȡȢ¡ȰȪ™¡]ȯ‘“Ǔ“šè¡Ȫ‡ȡȯ‚ȡfȲšȡͧžȡͪ” ›ȣ‡ȡȯ‚Ȣ
fȲ¡˜ȡšȯͨ›ȡ•€ȡ“Ǘ“Ȣ€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ@
™Ǒ‘]”‚›Ø™ɉ€ȯ]’ȡš”š†ȡğǙǓ›ȯȯ¡Ǖ]”ȡf‚™ȯȪ¡˜ȡšȣ†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‡[
ŒȢȡš €šǑ‘™ȡ‡ȡ™ȯ‚ȡȡͪ’ȡȸ€Ȫ€ȡ›ȣ Ǘ…Ȣ
ޛȰ€ͧ›èŠ ˜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)
˜ɇ€Ȫ [”ǗŽ[¡Ȫ“ȯ€ȯ”¡›ȯ€Ȫ [ Ȳèȡ†Ȫ°‘ȯȡ‘ȯȢ¡ǗȱȪ™¡˜ȯšȣ”ǗŽ[ǔ‡à˜ȯ‘ȡšȣ¡Ȫ‚Ȣ€ȧ˜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‘Ǘȱ‚ȡ‘ǗȲ‚Ȣ)†ȡğǙͪƣȡ” “€š“ȯ€ȧǔèǓ˜Ʌžȡ “˜ȯšȯ
ͪǽƨ€Ȫ_—Ȣ€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 the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He has passed last exam and is eligible for
sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His attendance is regular, as per the instructions of
Government
We have verified all details as per te 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 the matter to the
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 action against the institute.
The institute is accredited by the Government and permission is given to conduct related course.

(Signature ) (Signature ) Date (Signature )


Scholarship Nodal Officer HOD Director/Prinicpal

Generated by Scholarship Portal as on 02/11/2019


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

Fresh Application Backward Classes & Minorities Welfare Dept.


Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2016-17
Applicant Unique ID: 2260711 Scheme : Post Metric Scholarship for OBC
Application ID: 1902761 First Time Lock Date: 19/10/2016
Version No: 1 Verification Code: 6614 Lock Date: 19/10/2016 IPAddress : 14.139.232.8

Your 10th Board Details 10th


Board Name: C.B.S.E. Board,
Year: 2013-14, Roll No.: 1178707

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

“ȪІȡğ†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)

Generated by Scholarship Portal as on 02/11/2019

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