GOVERNMENT OF GUJARAT Submit Date : 27/10/2021
Application No:
Umbrella Scheme for Education of ST Students Post-Matric 212200000000683639
Scholarship
Fresh Application
Student Basic Details
Name of Student : PATEL VISHAL PRAKASHBHAI
Name of Student (As per Aadhar) : VISHAL PRAKASHBHAI PATEL
Mother's Name : Shilaben
Date of Birth : 29/10/2001 Gender : Male
Category : ST(7ȵkɅlISKWĤiS Religion :Hindu
Caste : Dhodia(QsP]h Sh}zxx{WhɆkD\TjɅkVh^s
Aadhaar Status Verified: Yes(27/10/2021 19:37:00)
Annual Income of Parents/Guardian/Husband (Rs): 60000 Habitation Type: Rural
Mobile Number : 9510544382 E-mail Address : patelvishal57236@gmail.com
Aadhar No : 32xxxxxx1678 Parent/Guardian occupation: Agriculture(EpSj
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:
Current Address: Permanant Address:
State Gujarat State Gujarat
District Navsari District Navsari
Taluka Navsari Taluka Navsari
Village Village Mahudi
PinCode 396466 PinCode 396466
Address:MAHUDI BHIMPAL FALIYA, TA & DIST : NAVSARI, Address:MAHUDI BHIMPAL FALIYA, TA & DIST : NAVSARI,
396466 396466
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 32xxxxxx1678 Bank name : -
Mandate Date : - Status :
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 29xxxxxx6452 IFSC Code : BKID0002903
Student Name(As per Bank Name): VISHAL PRAKASHBHAI PATEL
Name of Bank : BANK OF INDIA
Branch Name & Address : SATEM
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
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.
5.I voluntarily give my consent to use my Aadhaar details
6.I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar
Student Academic Details
Present Course/Class/Trade Type: Arts
Present Course/Class/Trade Name : B.A. Bachelor Of Arts
Present Course/Class/Trade Year : 1ST YEAR(1st Semester/2nd Semester)
Studying in : Gujarat Enrollment No:
Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 212200000000683639 Print Date :27/10/2021
Present Institute District : Navsari Present Institute : Arts And Commerce College, Chovisi, Navsari
Admission Type : Regular Seat(Government Quota) Present Branch Course : -
Present Class Start Date : 01-Sep-2021 Present Course Completion Date : 25-Apr-2022
Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 11000
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 0
Total (Rs) 11000
Educational Break : No No. Of. Year in Break :
Are You Employed in any Organization/Establishment with leave without pay? : Not Applicable
Previous Education Detail
Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
11th Std/12 Std 12TH Arts P770369 2021 49.09
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 Income Certificate From the Concerned Authorised Authority/Persons
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 : 27/10/2021
Verify Mobile Number : Yes 27/10/2021
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.
Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 212200000000683639 Print Date :27/10/2021
This is to certify that student has regularly attended online/blended education and maintained minimum attendance criteria till date
for the A.Y. 2020 ±
The actual School/College/University online/blended education 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 212200000000683639 Print Date :27/10/2021
