1/6/25, 7:11 PM Summary Report
Details of Online Application Form for Post-Dec Scholarship and Fee Reimbursement (New) Session - (2024-25)
(For Deposit in Educational Institute)
Date of Print:- 06/01/2025
Registration Statement
District Name: MUZAFFARNAGAR
Name of Educational Institution : SHRI RAM COLLEGE,MZN
Registration Number: 020640102401395
Name of Student: Akshay Malik
Changed name of student if:
Name of Father / Husband: C/O: Sandeep Malik
Mother's Name: Sangeeta
Religion: Hindu
Other Backward Classes (excluding Minority
Class/Ethnic Group:
Backward Classes)
Date of birth: 20/11/2006
Gender: MALE
Mobile, Tel No : XXXXXX9477 ,
Email
High School Board CBSE Year of passing high school 2020
High School Board Ka Serial Name and Address of University/Institution
21237740
No from where High School passed
Academic Statement
1-Name of Course: BACHELOR OF COMPUTER APPLICATIONS
2-Course Why Branch: BACHELOR OF COMPUTER APPLICATIONS
3-Type of Course: Self financed 4-Class Year and Duration: 3,3
5-Entry is based on Lateral
NO 6-Residential / Day Student: Student
Entry
7-Date of Admission in First Year 8-Date of admission to the
16/08/2022 17/08/2024
of Course: current session of the course:
9-Registration No. in 10-Name of
Maa Shakumbhari
University/Board/Affiliating 30082843 University/Board/Affiliating
University
Agency Agency:
Admission to 11th Vocational
Course is based on Class 12 YES 12-Course Key Eligibility: Intermediate
Marks/Merit:
Admission to 13th current
course is through Entrance Test NO 14-Types of Entrance Exams
(UPSEE(AKTU)/JEECUP/NEET)
15-Counseling no 16-Entrance Exam Year Sele
17-Rank obtained in entrance 18-Cut-off marks obtained in
0 0
exam entrance exam
19-Statement of Educational Qualification (High School and other higher classes) for last years
Name of the
passing receipt
Number Educational Qualification Integer Percentage Board/University/Affiliating
year number
Agency
1 High school 2020 500.00 291.00 58.20 CBSE
2 Intermediate 2022 500.00 302.00 60.40 CBSE
https://scholarship.up.gov.in/PostMatric/FinalPrintInstitute.aspx?Appid=MDIwNjQwMTAyNDAxMzk1&mn=QUtTSEFZIE1BTElL&cs=Q29ubmVjdEN1cn… 1/3
1/6/25, 7:11 PM Summary Report
Personal details
20-Sub-caste:
21-Residential Permanent
KARODHA HATHI,SHAMLI -
Address:
22-Letter Transaction Address : KARODHA HATHI,SHAMLI -
23- Ration Card Number/Family
ID :
24-Type of disability (if
disabled):
(ii)-Disability Allowance (in Rs.):
25(i)-Disability %
(iv)-Disability Application
(iii)-Disability Certificate Number
Number:
Caste and Income statement
26-Caste Certificate No 742223017129 27-Date of Issue of Caste Certificate: 31/10/2022
28-Caste Certificate Application Form No: 222060030048406
29- Income from all sources of student /
student's family (Rs 0):
Annual 72000 30-I Certificate No. 742221027163
Date of issue of 31-I Certificate: 31/10/2022 32-I Certificate Application Form Number: 222060010065221
Bank statement
33-Name of Bank: 34-Name of District:
(where the student/student eats) (Where the student / female student eats)
35-Name of Branch: 36-Student's Bank Account No:
38-Student's Bank Account
37-IFS Code:
Name:
Statement of Charges
39(i)-Approved Annual Non-Refundable Compulsory Fees: 20897
Form Submission Date:-sion Date:- 06/01/2025
Declaration letter 5CD232EFD0ED7C586FDDCD3682650553
I hereby declare that the above entries/instructions are true and filled by me, I am not receiving any other scholarship from any other source and I am not serving anywhere. If
serving, the total annual income of me and my parents or guardians is less than Rs.2.00 lakhs (less than Rs.2.50 lakhs for Scheduled Castes/Scheduled Tribes). Annual returns
have not been filed by my parents in Income Tax Department. I have not taken admission in Shiksha session anywhere else apart from this institution. I shall duly comply with the
academic instructions of the institution and the minimum attendance of 75 percent prescribed for scholarship and fee reimbursement.
Any notice given in the application form along with attached residence and income certificate if the annual income of my parents is more than Rs 2.00 lakh (Rs 0-2.50 lakh for
Scheduled Castes/Scheduled Tribes) and other records are incorrect. He/she shall refund the scholarship and fee reimbursement amount with penal annual interest. If I fail to do
so, the Department shall be free to recover the amount received from me as revenue dues and take legal action against me.
I, the holder of Aadhaar number, hereby give my consent to SW/ST/OBC/Minority Departments to obtain my Aadhaar number and Demographic/OTP for Authentication with UIDAI.
SUB-AUA (SW/ST/OBC/Minority Departments) has informed that my Aadhar number will not be stored/shared and will be submitted to CIDR only for the purpose of
SC/ST/Gen/OBC/Min Scholarship benefits.
I consent to get my Aadhaar number for SC/ST/General Class/Backward Class/Minority Class scholarship to concerned departments for demographic and OTP authentication with
Unique Identification Authority of India. My Aadhaar number will not be shared / protected and will be used for scholarship schemes
Date : ................................ Place : .............. ...................
Signature/Thumb Mark of Mother/Father Signature of the student
(Guardian in case of death of mother/father)
Income Receipt-Session-(2024-25) - Class - Other Backward Classes (Except Small Backward Classes)
Annexure – 'F'
Registration Number:- 020640102401395
5CD232EFD0ED7C586FDDCD3682650553
https://scholarship.up.gov.in/PostMatric/FinalPrintInstitute.aspx?Appid=MDIwNjQwMTAyNDAxMzk1&mn=QUtTSEFZIE1BTElL&cs=Q29ubmVjdEN1cn… 2/3
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Receipt of application form for Dashamottar Scholarship and Fee Reimbursement
Mr./Mrs./Ms./ Akshay Malik Son/Daughter/Wife Mr. C/O: Sandeep Malik
Institute SHRI RAM COLLEGE, MZN Course BACHELOR OF COMPUTER APPLICATIONS
Original/Self-attested copies of the following documents along with the application form for Dashamotta Scholarship and
Fee Reimbursement have been obtained.
(To be checked and ticked by the office of the educational institution)
1- Photocopy of I certificate of applicant's parent/guardian (on prescribed format).
2- Photocopy of caste certificate of applicant (on prescribed format).
3- Photocopy of the receipt in the form of fee deposited in the institution. Not required for Scheduled Castes and
Tribes.
4- If there is a gap between the two rooms then a self-attested affidavit to that effect.
5- Copy of the fee receipt/certificate issued by the hostel if the student is staying in the hostel.
6- Photocopy of the passbook of the applicant's bank account on which the account number and IFS0 code is
printed.
7. Photocopy of High School Mark Sheet/Certificate.
8. Certificate of passing previous examination.
1. Photocopy of mark sheet.
2. Photocopy of certificate.
(Signature of the Officer/Employee of the Educational Institution receiving the application form)
Noun:
Designation:
Date:
With institution key seal.
https://scholarship.up.gov.in/PostMatric/FinalPrintInstitute.aspx?Appid=MDIwNjQwMTAyNDAxMzk1&mn=QUtTSEFZIE1BTElL&cs=Q29ubmVjdEN1cn… 3/3
