GOVERNMENT OF GUJARAT Submit Date : 02/12/2024

Application No:
Umbrella Scheme for Education of ST Students Post-Matric 242500000001705556
Scholarship
Fresh Application

Student Basic Details

Name of Student : Janjar Tejaskumar Jaysingbhai

Name of Student (As per Aadhar) : Janjar Tejasbhai Jesingbhai
Mother's Name : Bhartiben
Date of Birth : 21/03/2007 Gender : Male
Category : ST(7ȵkɅl‡ISKWĤiS  Religion :Hindu
Caste : Varli ah^_j ah_˜ 

Aadhaar Status Verified: Yes(22/11/2024 08:26:26)

Ration Card No. : 125004012443555 Ration Card Member No. : 125004003880878009

Name As Per Ration Card: (Janjar Tejasbhai Jesingbhai / Ĥ5K^SpKd[h:Ȑid„F[h:
EKYC Status As Per Ration Card: Yes EKYC Date: 02-10-2024
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): 60000 Habitation Type: Rural

Mobile Number : 7984056389 E-mail Address : [email protected]
Aadhar No : 91xxxxxx8407 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 Valsad District Valsad

Taluka Kaprada Taluka Kaprada

Village Kaprada Village Kaprada

PinCode 396065 PinCode 396065

Address:At&post.Kaprada,(gavantaka Address:At&post.Kaprada,(gavantaka
faliya),Subdist:kaprada,Dist:valsad,Gujrat,396065 faliya),Subdist:kaprada,Dist:valsad,Gujrat,396065

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 91xxxxxx8407 Bank name : -
NPCI Date : 12/18/2024 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 : 43xxxxxx2237 IFSC Code : SBIN0010983
Student Name(As per Bank Name): TEJASBHAI JESINGBHAI JANJAR

Name of Bank : STATE BANK OF INDIA

Branch Name & Address : KAPRADA

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

Page 1 of 3 242500000001705556 Print Date :20/12/2024

 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 : 1ST YEAR(1st Semester/2nd Semester)

Studying in : Gujarat Enrollment No: 240190105044

Present Institute District : Valsad Present Institute : GOVERNMENT ENGINEERING COLLEGE,

VALSAD 019
Admission Type : Regular Seat(Government Quota) Present Branch Course : -

Present Class Start Date : 27-Jun-2024 Present Course Completion Date : 15-Dec-2024

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 1500
Misc.Fee(NonRefundable Fees) 1945
Exam Fees(Rs) 1450

Total (Rs) 4895

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

Are You Employed in any Organization/Establishment with leave without pay? : Not Applicable

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH Standard Maths B5139041 2022 69.33

11th Std/12 Std 12TH Science B270938 2024 68.18

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 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 Income Certificate From the Concerned Authorised Authority/Persons

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 : 20/12/2024

Verify Mobile Number : Yes 18/12/2024

Place : Signature of the applicant

Page 2 of 3 242500000001705556 Print Date :20/12/2024

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 :

Page 3 of 3 242500000001705556 Print Date :20/12/2024