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    STSC92402284690492 1

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    STSC92402284690492 1

    Uploaded by

    umakantchhatria143
    20 views3 pages

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    STSC92402284690492-1

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    Copyright:

    © All Rights Reserved
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    20 views3 pages

    STSC92402284690492 1

    Uploaded by

    umakantchhatria143

    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 2023- 24
    STSC92402284690492
    Government of Odisha

    Basic Information

    Department Scheme Academic Year Application Type


    ST&SC and MBC Welfare Post Matric Scholarship 2023- 24 New
    Department

    Applicant Details

    Applicant Name Category Applicant Gender


    Sumit Chhatria SC Male

    Religion Date of Birth Aadhaar No.


    Hindu 08 Apr 2006 (17 Year) XXXXXXXX0188

     Bank account is seeded with Aadhaar when applied by student.

    Mobile No. Alternative Mobile No. e-Mail Id


    7815026030 6372147130 [email protected]

    Father's Name Father Educational Status Father Occupational Status


    Tikebabu Chhatria Not literate Agriculture

    Mother's Name Mother Educational Status Mother Occupational Status


    Mandara Chhatria Not literate House Wife

    Guardian Name Individual/ Family Information


    VIEW
    Tikebabu Chhatria Beneficiary of NFSA

    Address Information

    District Block/ULB GP/Ward


    Bolangir Saintala Ampali

    Village Pin Code Address


    Kusmal 767032 Khusmal

    Educational Qualification Details

    For : Matric- Annual

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

    X BSE, Odisha 045eg0153 2021 600 336 56.00 Uploaded

    Institute / Course Information (Current Education Information)

    Institute Type
    Govt. Aided

    Institute District Block/ULB


    Panchayat Higher Secondary School, Ghunsar Bolangir Saintala

    Nature of Course Course Branch/Stream/Trade


    General Plus 2 Arts

    Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date


    1st Year IA23- 070 08 Jul 2023

    Enrollment No. Enrollment Date


    IA23- 070 08 Jul 2023

    Any Exam Conducted during current academic year? : No

    Residential Status

    Whether
    Day Scholar

    Details of Last Exam Passed

    Course Passing Year Total Mark/CGPA


    X 2021 600

    Secured Marks/CGPA Percentage (%) Certificate


    336 56.0 Uploaded

    Eligibility Information

    Income Certificate No. Family Income (in Rs.) To Whom the Certificate Issued
    E- INC/2023/1214005   50000.00 TIKEBABU CHHATRIA

    Issuing Authority Issue Date Income Certificate


    Revenue Officers not below the rank of 04 Jul 2023 Uploaded
    Tahasildar / Additional Tahasildar

    Matriculation Certificate No. Issuing Authority Matriculation Certificate


    211159278 BSE, Odisha (Annual) Uploaded

    Caste Certificate No. To Whom the Certificate Issued Issuing Authority


    e- CAS/2019/1758  SUMIT CHHATRIA Revenue Officers not below the rank of
    Tahasildar / Additional Tahasildar

    Issue Date Caste Certificate


    08 Aug 2019 Uploaded

    Institute Declaration Certificate


    NA

    Bank Information

    Account Holder Name IFSC Code Account No.


    SUMIT CHHATRIA SBIN0003383 37128629000

    Whether account number tagged /seeded with


    the Aadhaar number?
    Yes

    Bank Name Branch Name


    STATE BANK OF INDIA SAINTALA

    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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