GOVERNMENT OF GUJARAT Submit Date : 26/11/2024

Application No:
BCK -325 Educational Assistance for NTDNT Students Studying in 242500000000020828
Self Financed College(NTDNT)
Renewal Application

Previous Application No: 232400000000730468

Previous Paid Scholarship:

Student Basic Details

Name of Student : Mitrala BRIJESHKUMAR BHIKHABHAI

Name of Student (As per Aadhar) : Brijeshkumar Bhikhabhai Mitrala
Mother's Name : KOKILABEN
Date of Birth : 18/08/1994 Gender : Male
Category : NT/DNT(iaI^iS7WpiaȺkƈSĤiS  Religion :Hindu
Caste : vaghari ahG^Ž 

Aadhaar Status Verified: Yes(26/11/2024 10:54:56)

Ration Card No. : 415005004606391 Ration Card Member No. : 415005004606391013

Name As Per Ration Card: (Brijeshkumar Bhikhabhai Mitrala / ‡̈ȐbȢk\h^[jEh[h:i\́h_h
EKYC Status As Per Ration Card: Yes EKYC Date: 24-09-2024
Aadhar Number Matched With Ration Card: Yes
Consent Status: I hereby give my consent to use my personal data available with food and civil supply department. I hereby give my consent to
government of Gujarat for fetching my identity for the purpose of post matric scholarship.

Annual Income of Parents/Guardian/Husband (Rs): 80000 Habitation Type: Rural

Mobile Number : 9586475603 E-mail Address : [email protected]
Aadhar No : 70xxxxxx4745 Parent/Guardian occupation: Agriculture(EpSj
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:

Current Address: Permanant Address:

State Gujarat State Gujarat

District Anand District Anand

Taluka Petlad Taluka Petlad

Village Bhatiel Village Bhatiel

PinCode 388450 PinCode 388450

Address:699 navapura vas Address:699 navapura vas

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 70xxxxxx4745 Bank name : -
NPCI Date : 11/26/2024 12:00:00 AM NPCI Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 54xxxxxx7680 IFSC Code : CBIN0280520
Student Name(As per Bank Name): BRIJESHKUMAR BHIKHABHAI
Mitrala
Name of Bank : CENTRAL BANK OF INDIA

Branch Name & Address : PETLAD

I hereby accept that
1.Details provided by me are correct to best of my knowledge

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 2.Shall not make any claims if amount is transferred to a wrong account due to incorrect details provided by me
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.

Student Academic Details

Present Course/Class/Trade Type: Engineering & Technology

Present Course/Class/Trade Name : B.E. (Bachelor of Engineering)

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

Studying in : Gujarat Enrollment No:

Present Institute District : Anand Present Institute :

IPCOWALA INSTITUTE OF ENGINEERING And
TECHNOLOGY DHARMAJ, ANAND 101
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : Mechanical Enginnering
Enter Your Research/Thesis Subject :
Present Class Start Date : 01-Jul-2024 Present Course Completion Date : 30-Jun-2025

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 53500
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 1700

Total (Rs) 55200

Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2024 Previous (%) : 7.15

Educational Break : Yes No. Of. Year in Break : 7

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH GSHSEB B239503 2009 57.23

Engineering & Technology B.E. (Bachelor of Engineering) mechanical 23101322 2024 7.15
9010
Engineering & Technology DE (Diploma Engineering ) mechanical 21951031 2023 9.47
9503
ITI ITI Industrial Training Institute (2 Year Course) Fitter 25304901 2013 74.86
3

List of documents which you have attached :

1 Caste Certificate From the Competent Authorities

2 First Page Of Bank PassBook/Cancelled Cheque

3 Fee Receipt of Current Course Year

4 Self Attested Certificate of Previous academic marksheet

5 Break Affidavit(If Break Gap is More than One Year)

6 Income Certificate (Competent Authority)(Form no.16 required For Govt. Employee)

7 School Leaving Certificate (If Any)

8 School/College Current Year Bonafide Certificate

9 Identity Card (College/School)

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.

Page 2 of 3 242500000000020828 Print Date :26/11/2024

Date : 26/11/2024

Verify Mobile Number : Yes 26/11/2024

Place : Signature of the applicant

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.

This is to certify that student has regularly attended classes and maintained minimum attendance criteria till date for the A.Y. 2024
-2025. If student will irregular, than we will immediately reported to the said authority.

The actual School/College/University year began on __________________ and will be ended on _____________________

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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