8/3/24, 9:21 PM LE402408035064322
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Scholarship Application Form
Labour & ESI Department
Academic Year 2023-24 LE402408035064322
Government of Odisha
Basic Information
Department Scheme Academic Year Application Type
Labour & ESI Department Nirman Shramik Kalyan Yojana 2023-24 New
(Edn Astt)
Father's Nirman Shramik ID Father's Aadhaar No.
ODBLS001088584 XXXXXXXX5478
Mothers's Nirman Shramik ID Mothers's Aadhaar No.
-- --
NOTE : Please verify the bottom and get the information in the Nirman Sarmika
portal.
Applicant Details
Applicant Name Father's Name Mother's Name
Kamalkrishna Behera NAROTTAM BEHERA KAJAL BEHERA
Guardian Name Applicant Gender DDD
-- Male 16 Sep 2007 (16 Year)
Aadhaar No. Mobile No. e-Mail Id
XXXXXXXX2607 9178021692 nanigopalbehera6@gmail.com
Category Religion
General Hindu
Beneficiary Details
Father's Registration Date Father's Date of Birth Mother's Registration Date
06 Dec 2018 25 Jul 1979 --
Mother's Date of Birth Nature of Job BPL/Antyodaya Mention Card No.
-- Unskilled Construction Worker --
Child Name
KAMALKRISHNA BEHERA
Address Information
District Block/ULB GP/Ward
Balasore Bhograi Kulida
Village Pin Code Address
Madhupur 756035 AT MADHUPUR PO MADHUPUR DIST
BALASORE
Educational Qualification Details
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Passing Total Secured Percentage Marksheet/
Course Board Roll No. Year Mark/CGPA Marks/CGPA (%) Certificate
X BSE, 135CA0065 2023 600 516 86.00 Uploaded
Odisha
Institute / Course Information (Current Education Information)
Institute Type
Govt. Aided
Institute District Block/ULB
Rural Institute of Higher Studies Higher Balasore Bhograi
Secondary School, Bhogarai
Nature of Course Course Branch/Stream/Trade
General Plus 2 Arts
Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date
1st Year 55 01 Aug 2023
Details of Last Exam Passed
Course Passing Year Total Mark/CGPA
X 2023 600
Secured Marks/CGPA Percentage (%) Certificate
516 86.0 Uploaded
Bank Information
Account Holder Name IFSC Code Account No.
NAROTTAM BEHERA PUNB0137820 1378010174695
Whether account number tagged /seeded with
the Aadhaar number?
Yes
Bank Name Branch Name
PUNJAB NATIONAL BANK DARUHA
Passbook front page
Uploaded
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Student Declaration
1. I have read and understood the conditions of award of Scholarship.
2. I am aware that my application is liable to be rejected, if it is found at any stage, that Aadhaar number provided by me is wrong or Aadhaar number is
of someone’s else.
3. I am aware that if more than one application is found, all my applications are liable to be rejected.
4. I am aware that for any wrong entry or mis-match of the Bank-account details, the State Government will not be responsible for mis-credit and I will
be held responsible for diversion of public money on this ground.
Date ........................
Place ........................
Full Signature of Applicant
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