IRENEWAL APPLICATION

Government of Chhattisgarh
A _S ta!e Scholarship Portal
pphcation Form for Year 2021-22

~~==~~:....:..:~~~---
uuii:ii"ir°Aru~~-:-:::-::-:-::::-=----~S::c:'.h:eme : Post Matric ST Scholarship
!APPLICATION ID: 21158732
APPLICATION DATE 25-11-2021
I ISTUDENT ID : 22137401221
VERIFICATION CODE 64263 IP ADDRESS 49 .36.33.76

1.Persooal Details
NAME DASHRATH
DATE OF BIRTH 28-06-2000 GENDER Male
AADHAR NUMBER xxxxx.xxx4601 MOBILE NUMBER 7067154853
EMAIL ADDRESS [email protected] RELIGION Hindu
IS ORPHAN No

FATHER'S NAME MANSING MOTHERSNAME BUDHAN

FATHER OCCUPATION Farmer MOTHER OCCUPATION Fanner

HOUSEHOLD CATEGORY BPL [ BPL
IS DIFFERENTLY ABLED No Number -
223747140123]

I
2,Academic Details
I
Current Course's Details
INSTITUTE GOVT. KAKTIYA P.G. COLLEGE JAGDALPUR ( Institute Id - 13740005 ), Block- JAGDALPUR, I
District- BAST AR ENROLL MENT DATE 26-12-2020 I
ENROLLMENT NO BVA20004576
ADM ISSION DATE 20-10-2021 I
ADMISSION TYPE Merit Basis I
MODE OF STUDY Regular Course
I
COURSE 8. Sc./ Branch- Science I Year- 2nd Year I
Current Course's Last Year Exam Details
COURSE YEAR 1st Year
LAST EXAM RESULT (%) [ PASS] 58 .80
I
Previous Completed Course Details
COURSE/ BRANCH/ YEAR/ PERCENT AGE SS (Plus 2) / 12th/ Science/ 2019/ 50 .80% \
I
SSC (10th Class) Details
YEAR OF PASSING 2017
I
BOARD NAME CGBSE
PERCENTAGE 61 .00 %
ROLL NUMBER 1175307979

ANNUAL INCOME : 60000

HOSTELLER OR DAY SCHOLAR : DAY SCHOLAR

3.Bank Details:
BANK NAME ORIENTAL BANK OF COMMERCE BRAN C H NAME JAGDALPUR,DISTT.BASTAR

IFSC CODE ORBC0101875 ACCOUNT NUMBER 18752122006931

4.Contact Details:
CORRESPONDANCEADDRESS PERMANENT ADDRESS

PATEL PARA BEDAUMARGAON BASTAR POST PATEL PARA BEDAUMARGAON BASTAR

KACHNAR, Block- BAKAWAND, District- BAST AR Postoffice- Kachnar B.O, CityNillage- '
Bedaumargaon, Block- BAKAWAND o· t .
BAST AR, Pincode- 494221 ' IS net-
I
Generated by Chhatt,sgarh State Schol
- h- ~ - - - -
II
Page 1 of 2 ars ,p Portal on dated ;>5 N
· ov-2021
 ga rh
Go ve rnm en t of Ch ha ttls
rta l
Sta te Sc ho lar sh ip Po
ar 202 1-2 2
Ap pli ca tio n Fo rm for Ye
ST Sc ho lar sh ip
Sc he me : Po st Ma tric

c:fA::.P:...P.=-Ll:.:C:.:..A:..:.T.:..:IO;_N_I_D_:_2_1
I
_15_8_7_32_ _ _ _......, ST
UD EN T ID : 22137401221
IP ADDRESS : 49.36.33.
76
64263
11-2021 VERIFICA TION CODE
APPLICATION DATE : 25-

09-201 9
s,Caste Certificate Detai
ls: CERTIFICATE DATE : 01-
: 0704011910005280
Yes CE RT IFICATE NUMBER
IS AVAILAB LE ON LI NE :

tails: 08- 201 9

6.Domicile Certificate De : 070701191000 5614
CERTIFICATE DATE : 09-
: Yes CERTIFICATE NUMBER
IS AVAILABLE ON LI NE

21
tails: 11-2 0
7.lncome Certificate De CERTIFICATE DA TE : 22-
: 070601211 001390 0
: Yes CERTIFICATE NUMBER
IS AVAILABLE ONLINE

>ich ~ l:.l~lSl 11
0
ren t - 3-i l~~ ch ~ Qlc
nt an d his /he r Pa
De cla rat ion Fr om Stu de no , caste cer tific ate an d
he reb y declare that board roll d
MA NS I NG and MA NS I NG ation form is com ple te an
1. We , DA SH RA TH S/o
de tail s and all oth er info rmation given 1n the applic ye ar in an y oth er
account scholarship for current aca
de mic
inc om e certificate , bank any other application for
We ha ve no t sub mit ted en ab ove is fou nd to be false at an y sta ge ,
correct. y info rm atio n giv
e leg al pe na l ac tion
o undertake that, if an thority will be free to initiat
institution in India. We als red and com pe ten t au
ip will be recove
en tire am ou nt of scholarsh
fi 10cfi qfl-a;n
ag ain st us .
cfl«t ~ f e n ~ ~ 1RJ" lT 3tmm -'rllci<hlfl 'QcT cnf
ING 3m MANSING ~
I ~ GR1 m« l ;a ~
S/o MA NS afl"
~ . DA S HR AT H
~ fcmur ~ ~ ~ ~ i
TT, ~ ~ c'fm
{ ~ ~
cfiJ ;mcf;~f'rc. ~ c'fm 3fl<T ~ ~ ~ ~ ~ 3tmm 1RJ"lT -'rllci<hlfl ~ aft @"
ci"fr f<nm "JmT ~ I ~ ~ fen
~ ~ ct; ~ ~ , J.l<h <hlii cllt \ cfi'r
~ ~ ~ ~ ~51 m ~
WT TTfw cfTT ~ cfTT ~ vci
~ ~ ~ cTI' ~ cfiJ
~ ~ t I

Signature of Stud ent

Si gn atu re of Parent
Check List

:-
Document to be attached
ity. D
from the competent author D
1 _Caste Certificate issued
ential Certificate hority/Persons D
2 Resid e Certificate from the concerned authorized aut D
· 1 com nt authority
Copy) Attested by Compe~e D
· ~ s .c . certificate (Photo
3
account no
4 e of Bank Passbook having
· Photo Copy of the first pag D
5
6: Last Year Mark Sheet