GOVERNMENT OF GUJARAT Submit Date :
Application No:
(BCk-6.1) Post Matric Scholarship for SC students (Government of 222300000002474635
India Scheme)(Freeship Card Student Only)
Fresh Application
Student Basic Details
Name of Student : Hajare Suhasini Pramodbhai
Name of Student (As per Aadhar) : Suhasini Pramodbhai Hajare
Mother's Name : Ranjanaben
Date of Birth : 06/11/2000 Gender : Female
Category : SC(7ȵkɅlISĤiS Religion :Hindu
Caste : Hindu Mahyavansi
eƛȳk\he]ha5bj
)
Aadhaar Status Verified: Yes(09/03/2023 17:53:00)
Annual Income of Parents/Guardian/Husband (Rs): 70000 Habitation Type: Rural
Mobile Number : 9638578968 E-mail Address : suhasihajare06@gmail.com
Aadhar No : 64xxxxxx6428 Parent/Guardian occupation: JOB
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 Umbergaon Taluka Umbergaon
Village Sarigam Village Sarigam
PinCode 396155 PinCode 396155
Address:Mahyavanshi street, Sarigam Address:Mahyavanshi street, Sarigam
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 64xxxxxx6428 Bank name : -
Mandate Date : - Status :
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 06xxxxxx5962 IFSC Code : BARB0SARIGA
Student Name(As per Bank Name): Suhasini Pramodbhai Hajare
Name of Bank : BANK OF BARODA
Branch Name & Address : SARIGAON, DIST VALSAD
I hereby accept that
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 : B.E. (Bachelor of Engineering)
Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)
Studying in : Gujarat Enrollment No: 211230106537
Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 222300000002474635 Print Date :09/03/2023
Present Institute District : Navsari Present Institute :
S S AGRAWAL INSTITUTE OF ENGINEERING
AND TECHNOLOGY 123
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : Civil Engineering
Enter Your Research/Thesis Subject :
Present Class Start Date : 26-Jul-2022 Present Course Completion Date : 30-Apr-2023
Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 63000
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 1700
Total (Rs) 64700
Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2022 Previous (%) : 50.00
Educational Break : No No. Of. Year in Break :
Freeship Card Detail
Freeship Card No: 161
Freeship Card Issued Date: 22/12/2021
Freeship Card Issued by District:Valsad
Previous Education Detail
Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH GENERAL B5222330 2016 56.6
11th Std/12 Std 12TH Science B 194136 2018 34.5
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 Income Certificate (Competent Authority)(Form no.16 required For Govt. Employee)
4 Std:10 Marksheet
5 School Leaving Certificate (If Any)
6 Std:12 Marksheet(If Any)
7 Graduate Marksheet(If Any)
8 Other Marksheets/Last Year Marksheet (If Any)
9 Freeship Card
10 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 : 09/03/2023
Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 222300000002474635 Print Date :09/03/2023
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. 2022
±2023.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 :
Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 222300000002474635 Print Date :09/03/2023
