Application Form - University Grants Commission

Application Form Printed on

10/10/2013 11:02:55 AM

GOI Post Matric Scholarship , 2013-2014

Course

12th Computer Science

Special Backward Class

Application Number

APPJ1266992M20122013

Appilcation type

New

Renewal Course Year

Please Paste Passport Size Photograph

2012

Student SSC Details SSC Board

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION

Passing Year

2012

SSC Seat No

j126699

SSC Marks Obtained

64.00

Applicant's Details Mother's Name

Applicant Name MAYURI

SUBHASH

SIRSIKAR

Date of Birth

Gender

Female

Is Resident of Maharashtra Maharashtra

Maritial Status

No

Caste Category

18-02-1996

Application Date 17-09-2013 Caste

Koshti (3-1)

Orphan

ARUNA

Special Backward Class

Sub Caste

No

Is Disabled

No

Disability Type

Is Applicant Salaried ? NO

Applicant's Annual Income

0.00

Total Annual Income 40000.00

Is Staying at Hostel ?

Has Applied For Hostel ?

No

N.A.

No

Student Prequalifying Details Academic Year

Institute

Course

Course Year

Percentage

Result

2012 - 13

NACSC WARDHA


1

59.53

Pass

2011 - 12

kesarimal kanya sch.wardha

SSC

1

64.00

Pass

2010 - 11

kesarimal kanya sch.wardha

9th Standard

1

60.00

Pass

Institution Details Name of School/College/Institute where Admitted

New Arts,Comm & Sci.Jr College Wardha

Course Name


Course Year

1

CAP Number

N.A

UID Number

379669926956

EID Number Subject

Academic Year

2013-2014

College Adm.No 8665

Admission Dt.

14-06-2013

Is Fees Paid ?

No

Fee Paid

0.00

N.A

GrantType

Non Granted

Fee Receipt Date Contact Details

Is Admission after No Diploma Joining Date 24-06-2013 Fee Receipt No. Quota Government Quota

Residential Number: , MobileNumber: , EmailAddress: Address For Correspondence Address:- Location:- City:- Wardha Pincode:- 442001 Taluka:- Wardha District:- Wardha

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Parent / Guardian Details Parent's name

SIRSIKAR

SUBHASH

Age

Relation with Applicant

(yrs)

Profession

Parmanent Address

Location:- City:- Wardha Pincode:- 442001 Taluka:- Wardha District:- Wardha

Is Father Alive

Yes

Annual Income 40000.00

Hostel Information Name of Landlord / Hostel

Hostel Admission Date

Hostel Type

Is Mess Service Available?

Hostel/ Landlord Address

No

Rent Per Month

0.00

Hostel/Landlord Contact Details

Is Studying in night school

Yes

Document Details Caste Certificate No

781

District Issuing Wardha Office

Taluka Issuing Office

Wardha

Caste Validity Certificate No

N.A

District Issuing Wardha Office

Scrutiny Committee No

N.A

Issued in

University Registration No

N.A

Income Certificate 8366 No Student Bank Account Details Bank Name

DENA BANK

Branch Name

WARDHA

IFSC Code

BKDN0521261

2012

Bank Account No

126110036614

MICR Code

NOT AVAILABLE

Document Attached Caste Certificate Issued by Competant Officer Income Proof Income Certificate Issued by Competant Authority Marksheets I-card Size Photo SSC Mark Sheet UID document xerox Declaration The information furnished by me is complete and correct. I bear the complete responsibility for all the above information. Applicant's Signature

_______________________

Principal's Signature

_______________________

Applicant Parent's Signature

_______________________

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