GOVERNMENT OF GUJARAT Submit Date : 04/12/2024

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 242500000000725844
Students
Fresh Application

Student Basic Details

Name of Student : Prajapati Govind Maheshbhai

Name of Student (As per Aadhar) : Prajapati Govind Maheshbhai
Mother's Name : Ashaben Maheshbhai Prajapati
Date of Birth : 27/11/2007 Gender : Male
Category : SEBC Religion :Hindu
Caste : Kumbhar Ȣk5[h^ 

Aadhaar Status Verified: Yes(26/11/2024 21:14:10)

Ration Card No. : 104001004164101 Ration Card Member No. : 104001004164101011

Name As Per Ration Card: (Prajapati Govind Maheshbhai / ̆ĤXiSFsia„U\e°b[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): 120000 Habitation Type: Rural

Mobile Number : 6352145230 E-mail Address : [email protected]
Aadhar No : 28xxxxxx9366 Parent/Guardian occupation: Pvt-Service(EhWFjWsD^Ž
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Private Hostel

Current Address: Permanant Address:

State Gujarat State Gujarat

District Patan District Mahesana

Taluka Patan Taluka Satlasana

Village Village
PinCode 384265 PinCode 384340

Address:Prajapati Hostel, Chamunda Soc., near Bansi kathiyawadi, Address:at. Sudasana, tl. Satlasana, di.Mahesana
Patan

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 28xxxxxx9366 Bank name : -
NPCI Date : 12/1/2024 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 : 72xxxxxx6116 IFSC Code : BARB0BGGBXX
Student Name(As per Bank Name): GOVIND MAHESHBHAI
PRAJAPATI
Name of Bank : BARODA GUJARAT GRAMIN BANK

Branch Name & Address : BARODA GUJARAT GARMIN BANK

I hereby accept that

Page 1 of 3 242500000000725844 Print Date :04/12/2024

 1.Details provided by me are correct to best of my knowledge
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 : DE (Diploma Engineering )

Present Course/Class/Trade Year : 2ND YEAR(3rd Semester/4th Semester)

Studying in : Gujarat Enrollment No: 236310307150

Present Institute District : Patan Present Institute : K.D.Polytechnic,Patan 631

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

Enter Your Research/Thesis Subject :

Present Class Start Date : 27-Jun-2024 Present Course Completion Date : 30-Jun-2025

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 500
Misc.Fee(NonRefundable Fees) 51
Exam Fees(Rs) 150

Total (Rs) 701

Previous stream :DE (Diploma Engineering ) Previous Class/Course : 1ST YEAR(1st Semester/2nd Semester)
Previous Passing Year : 2024 Previous (%) : 7.10

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

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH General B8216310 2023 78

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 Hostel Certificate(Only For Hosteller Student)

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

7 School Leaving Certificate (If Any)

8 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 242500000000725844 Print Date :04/12/2024

Date : 04/12/2024

Verify Mobile Number : Yes 04/12/2024

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 :

Page 3 of 3 242500000000725844 Print Date :04/12/2024