GOVERNMENT OF GUJARAT Submit Date : 20/12/2024
Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 242500000001612295
Students
Fresh Application
Student Basic Details
Name of Student : JOSHI KIRTANBHAI DIPESHBHAI
Name of Student (As per Aadhar) : JOSHI KIRTANBHAI DIPESHBHAI
Mother's Name : JANKIBEN
Date of Birth : 16/11/2008 Gender : Male
Category : EBC(8iTD^SpXJhSaF½ Religion :Hindu
Caste :
Aadhaar Status Verified: Yes(18/11/2024 12:08:35)
Ration Card No. : 114011008736751 Ration Card Member No. : 114011008736751008
Name As Per Ration Card: (Joshi Kirtanbhai Dipeshbhai / KscjDS½W[h9UXpb[h9
EKYC Status As Per Ration Card: Yes EKYC Date: 30-08-2024
Aadhar Number Matched With Ration Card: Yes
Consent Status: I hereby give my consent to use my personal data available with food and civil supply department. I hereby give my consent to
government of Gujarat for fetching my identity for the purpose of post matric scholarship.
Annual Income of Parents/Guardian/Husband (Rs): 150000 Habitation Type: Urban
Mobile Number : 9106674995 E-mail Address : jkirtan35@gmail.com
Aadhar No : 49xxxxxx7340 Parent/Guardian occupation: Labour(\ȩl^
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:
Current Address: Permanant Address:
State Gujarat State Gujarat
District Bhavnagar District Bhavnagar
Taluka Mahuva Taluka Mahuva
Village Village
PinCode 364290 PinCode 364290
Address:OLD GLOB CINEMA MAHUVA Address:OLD GLOB CINEMA MAHUVA
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 49xxxxxx7340 Bank name : -
NPCI Date : 12/19/2024 12:00:00 AM NPCI Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 43xxxxxx4794 IFSC Code : SBIN0060412
Student Name(As per Bank Name): JOSHI KIRTANBHAI DIPESHBHAI
Name of Bank : STATE BANK OF INDIA
Branch Name & Address : MAHUVA, MARKET YARD
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
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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 : DE (Diploma Engineering )
Present Course/Class/Trade Year : 1ST YEAR(1st Semester/2nd Semester)
Studying in : Gujarat Enrollment No: 246490316096
Present Institute District : Bhavnagar Present Institute : Sir Bhavsinhji Polytechnic Institute, Bhavnagar 649
Admission Type : Regular Seat(Government Quota) Present Branch Course : Information Technology
Enter Your Research/Thesis Subject :
Present Class Start Date : 22-Jul-2024 Present Course Completion Date : 07-Dec-2025
Fees Amount
Admission Fees (Rs) 500
Tution Fees (Rs) 500
Misc.Fee(NonRefundable Fees) 1456
Exam Fees(Rs) 1100
Total (Rs) 3556
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 SSC C3093204 2024 86.66
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 (Competent Authority)(Form no.16 required For Govt. Employee)
6 School Leaving Certificate (If Any)
7 School/College Current Year Bonafide Certificate
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 : 20/12/2024
Verify Mobile Number : Yes 20/12/2024
Place : Signature of the applicant
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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. 2024
-2025. 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 :
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