“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application Backward Classes & Minorities Welfare Dept.

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2019-20
Applicant Unique ID: 3573898 Scheme : Post Metric Scholarship for OBC
Application ID: 4758880 First Time Lock Date: 20/11/2019
Version No: 1 Verification Code: 1987 Lock Date: 20/11/2019 IPAddress : 103.113.230.2
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sign in it.
Institute : [20042],Bhopal Institute of Technology and Science, Bhopal District: Course : B E [Full Time]/Electrical & Electronics
BHOPAL Engineering/1st Year [3016]

Old Scholarship Details(Before 2014-15 No Post Metric Scholarship was sanctioned Last Year.

Details Application Form 10th Board Data Samagra Data Counselling Data
Name AMIT KUMAR SAHU AMIT SAHU AMIT KUMAR SAHU

Father Name KAILASH PRASAD SAHU Kailash Sahu KAILASH PRASAD SAHU

DOB 06/08/2002 06/08/2002 06/08/2002

Gender Male #”ǕǽŸ% Male #”ǕǽŸ% MALE #”ǕǽŸ%

Category OBC #\ͪ”% OBC #\ͪ”% OBC #\ͪ”%

Religion : Hindu Special Category : No Voter ID : -- I O

Aadhar No. : XXXXXXXX4927

2. Details As Per DigitalCaste Certificate : Reg No: RS/450/0106/56458/2015, Name : AMIT KUMAR, Father Name : I O
KAILASH PRASAD, Mother Name : ASHA BAI, Category : OBC, Caste : Teli(Rathore,Sahu)

3.Academic Details As Repoted by Student : Enrollment No. : 0124EX191003 Admission Date :01/08/2019 I O

Details As Repoted by Student Counselling Details

Admission Mode Centralized Counselling

Institute [20042],Bhopal Institute of Technology and Science, Bhopal Institute of Technology Science Bhopal (20
Bhopal District: BHOPAL
Course B E [Full Time]/Electrical & Electronics Electrical Electronics Engineering
Engineering/1st Year [3016]
Academic Year 2019-20

Hostel Admission Non-Hosteler(Day-Scholar) --

Last Year Exam Details : Exam Name: HIGHER SECONDARY, Exam Date : 01/03/2019
I O
School./Institute :SARASWATI SISHU MANDIR HS SCHOOL BARHI KATNI Result : PASS
School Scholarship Details Generated From Samagra Portal
Name : AMIT SAHU Category : OBC DOB : XXXXXX2002 Gender : Male
Father Name : KAILASH SAHU BPL : “¡ȣȲ CWSN : No

Sno Academic Year School Current Class

1 2018-19 Saraswati Shishu Mandir/higher Secondary School Barhi 12 th
2 2017-18 Saraswati Shishu Mandir/higher Secondary School Barhi 11 th
3 2016-17 Saraswati Shishu Mandir/higher Secondary School Barhi 10 th
4 2015-16 Saraswati Shishu Mandir/higher Secondary School Barhi 9 th
5 2014-15 veena purwmadhyamik vidya mandir 8 th
6 2013-14 veena purwmadhyamik vidya mandir 7 th

4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2016-2017, Roll No.: 177232521 I O

5. Total Annual Family Income : Rs.70000/-

Generated by Scholarship Portal as on 20/11/2019

 “ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application Backward Classes & Minorities Welfare Dept.

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2019-20
Applicant Unique ID: 3573898 Scheme : Post Metric Scholarship for OBC
Application ID: 4758880 First Time Lock Date: 20/11/2019
Version No: 1 Verification Code: 1987 Lock Date: 20/11/2019 IPAddress : 103.113.230.2
Income Certificate : issued by-LOK SEWA KENDRA
VIJAYRAGHAVGARH ON : 04/06/2019
Father/ Husband Occupation : Farmer / Agriculture, Income: 70000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-

6. Contact Details Mobile No : 8305386721 amitkumarsahu488[AT]gmail[DOT]com I O

Correspondance Address : h no- 540 ward- no- 14, District :- KATNI

Permanent Address : h no- 540 ward- no- 14, District :- KATNI

7. Bank Account No: 9472500100495501, IFS Code: KARB0000947, KARNATAKA BANK LTD, ROHIT NAGAR I O
BHOPAL, BHOPAL

8. Change History NIL I O

ALERT: Details of Applications already registered by using same Samagra ID :
Nil
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil

]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration From Student and his Parent

1. We, AMIT KUMAR SAHU S/o KAILASH PRASAD SAHU and KAILASH PRASAD SAHU hereby declare that Board Roll No, Samagra ID, caste
certificate and income certificate, bank account details and all other information given in the application form is complete and correct. We have not
submitted any other application for scholarship for current academic year in any other institution in India. We also undertake that, if any information
given above is found to be false at any stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal
action against us.
¡˜AMIT KUMAR SAHU S/o KAILASH PRASAD SAHU kšKAILASH PRASAD SAHU ƒȪŸŽȡ€šȯ¡ɇ
ͩ€`”šȪƠ‡ȡ“€ȡšȣ ¡ȣ¡ȰfȲ ˜Ē]_ŒȢ€¢ȡCB–ȪŒ[”šȣ¢ȡ€ȧ˜ȡ€[žȢŠ‡ȡǓȡ]™Ĥ˜ȡŽ”ğ–ɇ€\€ȡ`ȲŠȡ\ۙ
ͪšŽ”ǗŽ[fȲ ¡ȣ¡Ȱ@]ȯ‘€“ȯ”ȪŠ[›”š^  ğ˜ȯè€Ȫ›šͧž”€ȯͧ›f€ȯ›f€¡ȣ]ȯ‘“ͩ€™ȡ¡Ȱ@\‚š`”šȪƠ‡ȡ“€ȡšȣ‚›”ȡ_
‡ȡȢ¡ȰȪ™¡]ȯ‘“Ǔ“šè¡Ȫ‡ȡȯ‚ȡfȲšȡͧžȡͪ” ›ȣ‡ȡȯ‚ȢfȲ¡˜ȡšȯͨ›ȡ•€ȡ“Ǘ“Ȣ€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ@
™Ǒ‘]”‚›Ø™ɉ€ȯ]’ȡš”š†ȡğǙǓ›ȯȯ¡Ǖ]”ȡf‚™ȯȪ¡˜ȡšȣ†ȡğǙͪƣǓ“šè€š‘ȣ‡ȡȯ‚Ȣȡ†ȡğǙͪƣ€ȧǔ‡“Ȣš€˜‘ȣ‚_
¡Ȱ` ȯȡ” ›ȯ›ȣ‡ȡȯ‚Ȣ)^ š¡€ȯͩЙȡ€›ȡ” ȯ ˜ǔےͪ’ȡȸ€Ȫ¡˜ȯžȡ€ȯͧ›fͩ€ Ȣ—Ȣ™Ȫ‡“ȡ€ȯ\ۏ‚[ͩ€ Ȣ—Ȣ†ȡğǙͪƣ
ȯͪǔ‡[ ŒȢȡš €šǑ‘™ȡ‡ȡ™ȯ‚ȡȡͪ’ȡȸ€Ȫ€ȡ›ȣ Ǘ Ȣ ޛȰ€ͧ›èŠ ˜ɅŒȡ›Ǒ‘™ȡ‡ȡ™ȯ‚ȡȡ†ȡğǙͪƣèȢ€Ǚ€ȡ[\ͬ’€ȡšȣ\ȡ
\ۙ ¢˜\ͬ’€ȡšȣ]æ™€ ˜ˆȯ‚ɅȪ` €ȯͪǽڑ—ȡšȢ™‘ÖŒ ȲǑ¡ȡ€ȧ’ȡšȡjȲfȲ€ȯ¡
f•]_]š‘‡[€šȡ_‡ȡ€š ɏ€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ)
˜ɇ€Ȫ [”ǗŽ[¡Ȫ“ȯ€ȯ”¡›ȯ€Ȫ [ Ȳèȡ†Ȫ°‘ȯȡ‘ȯȢ¡ǗȱȪ™¡˜ȯšȣ”ǗŽ[ǔ‡à˜ȯ‘ȡšȣ¡Ȫ‚Ȣ€ȧ˜ȯšȯƮȡšȡ”Ǘ[˜Ʌ Ȳ–Ȳͬ’€Ȫ [€ȯͧ›™ȯĤȡƯ
†ȡğǙͪƣžȡ “€Ȫ Ȳ–Ȳͬ’ǔ‡›ȡ€ȡ™ȡ[›™€ȯ˜ȡڙ˜ ȯ ȡ›ȡ“ ȯȡ” €š‘Ǘȱ‚ȡ‘ǗȲ‚Ȣ)†ȡğǙͪƣȡ” “€š“ȯ€ȧǔèǓ˜Ʌžȡ “˜ȯšȯ
ͪǽƨ€Ȫ_—Ȣ€ȡ™[ȡ¡ȣ€š“ȯ€ȯͧ›™ȯ蝏Ȳğš¡ȯ‚ȡ)

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢š Date (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

Declaration from Institute Head & Institute Scholarship Nodal Officer
We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He has passed last exam and is eligible for
sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him for sanction of scholarship as per the rules. We also
undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter to the
concerned district office so that his scholarship can be put on hold. In case any information of found to be incorrect, Government will be free to
initiate action against the institute.
The institute is accredited by the Government and permission is given to conduct related course.

(Signature ) (Signature ) Date (Signature )

Scholarship Nodal Officer HOD Director/Prinicpal

Generated by Scholarship Portal as on 20/11/2019

 “ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application Backward Classes & Minorities Welfare Dept.

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2019-20
Applicant Unique ID: 3573898 Scheme : Post Metric Scholarship for OBC
Application ID: 4758880 First Time Lock Date: 20/11/2019
Version No: 1 Verification Code: 1987 Lock Date: 20/11/2019 IPAddress : 103.113.230.2

Generated by Scholarship Portal as on 20/11/2019

 “ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”\”“ȯǔ‡›ȯ€ȯ€ȡ™ȡ[›™€›ȯȊšǔ‡›ȡBHOPAL €ȯ ͪ”†°ȡ‚[€ã™ȡŽ ˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Fresh Application Backward Classes & Minorities Welfare Dept.

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2019-20
Applicant Unique ID: 3573898 Scheme : Post Metric Scholarship for OBC
Application ID: 4758880 First Time Lock Date: 20/11/2019
Version No: 1 Verification Code: 1987 Lock Date: 20/11/2019 IPAddress : 103.113.230.2

Your 10th Board Details 10th

Board Name: MP Board of
Secondary Education, Year: 2016-
2017, Roll No.: 177232521

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢š Date (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

“ȪŠ†ȡğ†ȡğȡ€ȯ]ȯ‘“•Ȩ˜[”š™Ǒ‘€¢ȡȢ€ȡͪšŽ`”›Þ’“¡ȣȲ¡Ȫ“ȯ”š ȲèȡĤ˜Ǖ†ȡğ†ȡğȡ€ȯȢ€ȧ˜Ǘ›ĤǓ ˜ȡ€[žȢŠ  ȯ

‡ȡ“€ȡšȣ יȡͪ”€šȯ)

Generated by Scholarship Portal as on 20/11/2019