GOVERNMENT OF GUJARAT Submit Date : 02/12/2024

Application No:
(BCk-6.1) Post Matric Scholarship for SC students (Government of 242500000000725555
India Scheme)(Freeship Card Student Only)
Fresh Application

Student Basic Details

Name of Student : SOSA YAGNIKBHAI PARBATBHAI

Name of Student (As per Aadhar) : SOSA YAGNIKBHAI PARBATBHAI
Mother's Name : DIVALIBEN
Date of Birth : 14/11/2004 Gender : Male
Category : SC(7ȵkɅl‡ISĤiS  Religion :Hindu
Caste : Hindu Vankar ˆeƛȳkaRD^ 

Aadhaar Status Verified: Yes(02/12/2024 22:35:33)

Ration Card No. : 112014011245810 Ration Card Member No. : 112014011245810004

Name As Per Ration Card: (Sosa Yagnikbhai Parbatbhai / dsdh]h‡ìD[h:X^ZS[h:
EKYC Status As Per Ration Card: Yes EKYC Date: 27-10-2024
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): 65000 Habitation Type: Rural

Mobile Number : 7862030047 E-mail Address : [email protected]
Aadhar No : 78xxxxxx1120 Parent/Guardian occupation: Labour(\ȩl^Ž
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Private Hostel

Current Address: Permanant Address:

State Gujarat State Gujarat

District Surat District Gir Somnath

Taluka Adajan Taluka Gir Gadhada

Village Adajan Village Kanakiya

PinCode 395001 PinCode 362530

Address:5RJ4+3MX, Kalpana Chawla Marg, Maktampur, Address:AT KANAKIYA TA GIR GADHADA DIST GIR
Athwalines, Athwa, Surat, Gujarat 395001 SOMNATH 362530

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 78xxxxxx1120 Bank name : -
NPCI Date : 12/2/2024 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 : 35xxxxxx0743 IFSC Code : SBIN0060285
Student Name(As per Bank Name): YAGNIK PARBATBHAI SOSA

Name of Bank : STATE BANK OF INDIA

Branch Name & Address : DOLASA

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: ET22BTIT129

Present Institute District : Surat Present Institute : SARVAJANIK COLLEGE OF ENGG. And TECH. ,
SURAT 042
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : Information Technology

Enter Your Research/Thesis Subject :

Present Class Start Date : 03-Jul-2024 Present Course Completion Date : 27-Apr-2025

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 118000
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 0

Total (Rs) 118000

Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2024 Previous (%) : 73.16

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

Freeship Card Detail
Freeship Card No: 378
Freeship Card Issued Date: 01/10/2022
Freeship Card Issued by District:Gir Somnath

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH GENERAL C9286627 2020 71.5

11th Std/12 Std 12TH SCIENCE B203621 2022 53.69

Engineering & Technology B.E. (Bachelor of Engineering) INFORMATION ET22BTI 2023 7.1
TECHNOLOGY T129
SEM-1
Engineering & Technology B.E. (Bachelor of Engineering) INFORMATION ET22BTI 2023 7.7
TECHNOLOGY T129
SEM-2
Engineering & Technology B.E. (Bachelor of Engineering) INFORMATION ET22BTI 2023 7.27
TECHNOLOGY T129
SEM-3
Engineering & Technology B.E. (Bachelor of Engineering) INFORMATION ET22BTI 2024 7.3
TECHNOLOGY T129
SEM-4

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

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 2 First Page Of Bank PassBook/Cancelled Cheque

3 Fee Receipt of Current Course Year

4 Hostel Certificate(Only For Hosteller Student)

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

6 Std:10 Marksheet

7 School Leaving Certificate (If Any)

8 Std:12 Marksheet(If Any)

9 Other Marksheets/Last Year Marksheet (If Any)

10 Freeship Card

11 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.

Date : 04/12/2024

Verify Mobile Number : Yes 02/12/2024

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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