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    Scholarship Application Form: Basic Information

    Uploaded by

    Rock Hemanta
    Deepak Swain has applied for renewal of the Post Matric Scholarship for the academic year 2021-22. He is currently pursuing his 2nd year of B.Tech in Electronics and Communications Engineering at Gandhi Institute for Technology. In the previous academic year 2021, he passed his 1st year with 74.39% marks. He belongs to the OBC category and comes from a family with an annual income of Rs. 62,000. All required documents like income, caste, and educational certificates have been uploaded along with his bank details for fund transfer. He has declared that he understands and will abide by the scholarship rules.

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    Scholarship Application Form: Basic Information

    Uploaded by

    Rock Hemanta
    70 views3 pages
    Deepak Swain has applied for renewal of the Post Matric Scholarship for the academic year 2021-22. He is currently pursuing his 2nd year of B.Tech in Electronics and Communications Engineering at Gandhi Institute for Technology. In the previous academic year 2021, he passed his 1st year with 74.39% marks. He belongs to the OBC category and comes from a family with an annual income of Rs. 62,000. All required documents like income, caste, and educational certificates have been uploaded along with his bank details for fund transfer. He has declared that he understands and will abide by the scholarship rules.

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    Deepak Swain has applied for renewal of the Post Matric Scholarship for the academic year 2021-22. He is currently pursuing his 2nd year of B.Tech in Electronics and Communications Engineering at Gandhi Institute for Technology. In the previous academic year 2021, he passed his 1st year with 74.39% marks. He belongs to the OBC category and comes from a family with an annual income of Rs. 62,000. All required documents like income, caste, and educational certificates have been uploaded along with his bank details for fund transfer. He has declared that he understands and will abide by the scholarship rules.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views3 pages

    Scholarship Application Form: Basic Information

    Uploaded by

    Rock Hemanta
    Deepak Swain has applied for renewal of the Post Matric Scholarship for the academic year 2021-22. He is currently pursuing his 2nd year of B.Tech in Electronics and Communications Engineering at Gandhi Institute for Technology. In the previous academic year 2021, he passed his 1st year with 74.39% marks. He belongs to the OBC category and comes from a family with an annual income of Rs. 62,000. All required documents like income, caste, and educational certificates have been uploaded along with his bank details for fund transfer. He has declared that he understands and will abide by the scholarship rules.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Scholarship Application Form

    ST&SC and MBC Welfare Department


    Academic Year 2021-22
    STSC9211008765427
    Government of Odisha

    Basic Information

    Department Scheme Academic Year Application Type


    ST&SC and MBC Welfare Post Matric Scholarship 2021-22 Renew in Same Course
    Department

    Applicant Details

    Applicant Name Category Applicant Gender


    Deepak Swain OBC/SEBC Male

    Religion Date of Birth Aadhaar No.


    Hindu 04 Nov 2002 XXXXXXXX8626

    Mobile No. Alternate Mobile No. e-Mail Id


    7847878909 9556355668 [email protected]

    Father's Name Father Educational Status Father Occupational Status


    Gopabandhu Swain Literate Agriculture

    Mother's Name Mother Educational Status Mother Occupational Status


    Santilata Swain Not literate House Wife

    Guardian Name Individual/ Family Information


    VIEW
    Gopabandhu Swain Beneficiary of NFSA

    Address Information

    District Block/ULB GP/Ward


    Puri Pipili Dhandamakundapur

    Village Pin Code Address


    Karimula 752104 AT-BAITANGI
    PO-DANDAMUKUNDAPUR
    PS-
    PIPILI
    DIST-PURI
    PIN-752104
    ODISHA

    Educational Qualification Details

    For : Matric-Annual

    Course Board Roll No. Passing Year Total Mark/CGPA Secured Marks/CGPA Percentage (%) Certificate

    X BSE, Odisha 067BA0046 2018 600 450 75.00 Uploaded

    Plus 2 CHSE, Odisha 320MC183 2020 600 476 79.33 Uploaded

    Institute / Course Information (Current Education Information)

    Institute District Block/ULB


    Gandhi Institute for Technology(GIFT) Khurdha Khordha

    Course Branch/Stream/Trade Course Year (Current Year of Study)


    Engineering - B.Tech Course Electronics and Communications Engineering 2nd Year

    Admission/Registration No. Admission/Readmission Date Enrollment No.


    2001298272 02 Jul 2021 2001298272
    Enrollment Date
    01 Dec 2020

    Any Exam Conducted during current academic year? : Yes

    Exam Type Total Mark/CGPA Secured Mark/CGPA Percentage (%)

    1st Semester/Periodic 10 7.83 74.39

    Residential Status

    Whether
    Day Scholar

    Details of Last Exam Passed

    Course Course Year Passing Year


    Engineering - B.Tech Course 1st Year 2021

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


    10 7.83 74.39

    Certificate
    Uploaded

    Eligibility Information

    Income Certificate No. Family Income To Whom the Certificate Issued


    E-INC/2020/635265   62000.00 GOPABANDHU SWAIN

    Issuing Authority Issue Date Income Certificate


    Revenue Officers not below the rank of 18 Nov 2020 Uploaded
    Tahasildar / Additional Tahasildar

    Matriculation Certificate No. Issuing Authority Matriculation Certificate


    1801109473 BSE, Odisha (Annual) Uploaded

    Caste Certificate No. To Whom the Certificate Issued Issuing Authority


    E-SEB/2021/344354  DEEPAK SWAIN Revenue Officers not below the rank of
    Tahasildar / Additional Tahasildar

    Issue Date Caste Certificate


    25 Oct 2021 Uploaded

    Bank Information

    Account Holder Name IFSC Code Account No.


    DEEPAK SWAIN SBIN0009628 34228632418

    Whether account number tagged /seeded with Bank Name Branch Name
    the Aadhaar number? STATE BANK OF INDIA DANDAMUKUNDAPUR
    Yes

    Passbook front page


    Uploaded
    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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