GOVERNMENT OF GUJARAT Submit Date : 16/10/2019

Application No:
BCK-81A Post Matric Scholarship of Government of India for the 192000000000346154
OBC students
Renewal Application

Previous Application No: 181000000000301878

Previous Paid Scholarship:

Student Basic Details

Name of Student : vaghela Om Shaileshbhai
Name of Student (As per Aadhar) : Om Shaileshbhai vaghela
Mother's Name : VARSHABEN
Date of Birth : 02/05/2000 Gender : Male
Category : SEBC Religion :Hindu
Caste : Mochi(Other than Dang District and Umargam Taluka of Valsal District)(\sIj
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Aadhaar Status Verified: Yes(15/10/2019 23:01:00)

Annual Income of Parents/Guardian/Husband (Rs): 68000 Habitation Type: Urban

Mobile Number : 9601669984 E-mail Address : [email protected]
Aadhar No : 35xxxxxx6047 Parent/Guardian occupation: Tailor(U^ĥ
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:

Current Address: Permanant Address:

State Gujarat State Gujarat

District Ahmadabad District Ahmadabad

Taluka Maninagar Taluka Maninagar

Village Village
PinCode 382350 PinCode 382350

Address:12,sarita so.,opp.indrajit so.,nikol road , Ahmedabad. Address:12,sarita so.,opp.indrajit so.,nikol road , Ahmedabad.

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 35xxxxxx6047 Bank name : XXXX Bank
Mandate Date : 4/25/2019 12:00:00 AM Status : Inactive
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 31xxxxxx8992 IFSC Code : BARB0BAPUNA
Student Name(As per Bank Name): om shaileshbhai vaghela

Name of Bank : BANK OF BARODA

Branch Name & Address : BAPUNAGAR BR, AHMEDABAD

I hereby accept that
1.Details provided by me are correct to best of my knowledge
2.Shall not make any claims if amount is transferred to a wrong account due to incorrect
3.Shall refund the amount transferred to someone else¶s account due to incorrect details provided by me
4.I will refund the excess amount credited to my account, if any.
5.I voluntarily give my consent to use my Aadhaar details
6.I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar

Student Academic Details

Present Course/Class/Trade Type: Engineering & Technology

Present Course/Class/Trade Name : DE (Diploma Engineering )

Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)

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 Studying in : Gujarat Enrollment No: 176170309117

Present Institute District : Ahmadabad Present Institute : Government Polytechnic Ahmedabad 617

Admission Type : Regular Seat(Government Quota) Present Branch Course : Electrical Engineering

Enter Your Research/Thesis Subject :

Present Class Start Date : 17-Jun-2019 Present Course Completion Date : 26-Oct-2020

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 1000
Misc.Fee(NonRefundable Fees) 1080
Exam Fees(Rs) 1100

Total (Rs) 3180

Previous stream :DE (Diploma Engineering ) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2019 Previous (%) : 67.40

Educational Break : No No. Of. Year in Break :

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH SSC A1011758 2015 61

Engineering & Technology DE (Diploma Engineering ) Electrical D213056 2018 75.1

Engineering
Engineering & Technology DE (Diploma Engineering ) electrical D314568 2018 65.1
engineering
Engineering & Technology DE (Diploma Engineering ) ELECTRICAL D415382 2019 67.4

Disablity Detail
Is Disability : No Type of Disability : -

Percentage of disability : - Required Guide/Coaching Guide: No

Guide Name: -
Guide Address: -

List of documents which you have attached :

1 Caste Certificate issued by Competent authorities

2 First Page Of Bank PassBook/Cancelled Cheque showing IFSC code and account no

3 Fee Receipt of Current Course Year

4 Marksheet of Previous academic last board/university examination

5 Income Certificate issued by Competent Authorities

6 School Leaving Certificate(If any)

7 Identity Card Issued by College/University/School/Institute (If any)

I have read all above terms and conditions and understand them fully, I hereby declared that here I am submitting only one
application for scholarship and I haven¶t received any other scholarship/stipend or fellowship in this current session under any other
central/state government scheme. I further state that all information furnished by me is correct to my knowledge in case of any the
false information or suppression of necessary data proved in my application is liable to get cancelled at any stage of the scholarship
process and the entire amount of scholarship will be refunded by me or recovered from me. Government decision shall be final and
binding on me.

Date : 06/11/2019
Verify Mobile Number : Yes 06/11/2019
Place : Signature of the applicant

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It is certified that the information filled in the above mentioned fields by the students are correct to the best of my knowledge and
all the Documents has been checked.

It is also certified that in case the applicant leaves institution or otherwise discontinues the studies or detained or accepts any other
regular scholarships/stipend/ fellowship the fact will be immediately reported to the said authority

Certified that the student is eligible for scholarship amount subject to Central/State government rules and the student is
recommended for sanction of scholarship.

Signature Of Head Of The School/College/Institute/University With Official Seal

Place :
*Note : Stamp Signature will not be accepted

Date :

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