Submit Date : 02/01/2024
Application No:
GOVERNMENT OF GUJARAT 232400000001895319
BCK-79 Food Bill Assistance For Medical,Engineering Students
(SEBC)
Fresh Application
Student Personal Details
Name of Student : Kalasariya Nilesh Bhavanbhai
Name of Student (As per Aadhar) : Kalasariya nilesh bhavanbhai
Mother's Name : Manjulaben
Date of Birth : 07/02/2002 Gender : Male
Category : SEBC Religion :Hindu
Caste : Ahir Pancholi 8e^X5Is`
Aadhaar Status Verified: Yes(02/01/2024 18:21:00)
Annual Income of Parents/Guardian/Husband (Rs): 70000 Habitation Type: Rural
Mobile Number : 9998870345 E-mail Address : kalasariyanilesh2020@gmail.com
Aadhar No : 97xxxxxx2922 Parent/Guardian occupation: Casual Labour ġND\ȩl^
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Grant In AID Hostel
Current Address: Permanant Address:
State Gujarat State Gujarat
District Jamnagar District Amreli
Taluka Jamnagar City Taluka Rajula
Village Village Khakhbai
PinCode PinCode 365560
Address:Kashyap bhavan , ayurvedic u.g. boys hostel, jamnagar Address:Bhavanbhai , main bajar, khakhbai, amreli
Gujrat
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 97xxxxxx2922 Bank name : -
Mandate Date : 1/2/2024 12:00:00 AM Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 39xxxxxx4387 IFSC Code : SBIN0060215
Student Name(As per Bank Name): Kalasariya nilesh bhavanbhai
Name of Bank : STATE BANK OF INDIA
Branch Name & Address : RAJULA, A.D.B.
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: Medical
Present Course/Class/Trade Name : BAMS Bachelor of Ayurvedic Medicine and Surgery
Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 232400000001895319 Print Date :02/01/2024
Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)
Studying in : Gujarat Enrollment No: 2020001100000133
Present Institute District : Jamnagar Present Institute : Shri Gulab Kunvarba Ayurved College
Admission Type : Regular Seat(Government Quota) Present Course Branch : -
Present Class Start Date : 19-Jun-2023 Present Course Completion Date : 30-Apr-2024
Hostel Detail
Is Hostel run by Department No
Is Hostel attached With College Yes
Free facilities provided by Hostel? No
Previous stream :BAMS Bachelor of Ayurvedic Medicine and Surgery Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2023 Previous (%) : 50.96
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 C 2017 71.83
9008342
11th Std/12 Std 12TH science B 276480 2019 59.07
Medical BAMS Bachelor of Ayurvedic Medicine and 1st year 10060 2022 56.1
Surgery
Medical BAMS Bachelor of Ayurvedic Medicine and 2nd year 11012 2023 50.96
Surgery
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)
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.
Verify Mobile Number: Yes 02/01/2024
Place : Signature of the applicant
Date : 02/01/2024
Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 232400000001895319 Print Date :02/01/2024
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. 2023
-2024.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 _____________________
Date : Signature Of Head Of The School/College/Institute/University With Official Seal
Place :
*Note : Stamp Signature will not be accepted
Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 232400000001895319 Print Date :02/01/2024
