Fresh Application Government of Chhattisgarh

State Scholarship Portal 2.0

Application Form for Year 2018-19

Scheme : Post Matric SC Scholarship

Unique Applicant ID: 1120777 Application ID: 10118154

Version No: 1 Verification Code: 71045 Lock Date: 14/01/2019 IP Address : 47.247.34.230
1. Personal Details
Name : LOKNATH RATNAKAR Gender : Male

Father's Name : PHAGU RAM Mother's Name : KAUSHILYA

Date of Birth : 08/05/1997
Category : SC Aadhar No: ********5457

2. Academic Details Admission Date : 11/08/2018

Institute : [6166]-LCIT College of Commerce and Science Bodri,Bilha [Bilaspur]

Course : [1356]-Computer Application-PGDCA- Enrollment No : BUS/15/708/4
1st Year
10th Class Details: State Board /2012-2013 /1133512805 Last Exam Result % : [PASS]60.83

3. Hostel Status
Hosteller : No

4. Total Annual Family Income

Annual Family Income from all Sources: Rs.50000/-

5. Bank Details :
IFS Code of Branch : SBIN0000543 Account Number : 37829484044

6. Contact Details :
Correspondence AT PASID Permanent AT PASID
Address PO PASID Address PO PASID
TEH SARANGARH, DISTRICT :- Raigarh TEH SARANGARH, DISTRICT :-
, STATE :- Chhattisgarh , PIN CODE :- Raigarh , STATE :- Chhattisgarh , PIN
496445 CODE :- 496445

Contact Numbers : 7000168588 Email Address : Loknathratnakar[AT]gmai

]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration From Student and his Parent

1. We, LOKNATH RATNAKAR S/o PHAGU RAM and PHAGU RAM hereby declare that Board Roll No,
caste certificate and income certificate, bank account details and all other information given in the
application form is complete and correct. We have not submitted any other application for scholarship for
current academic year in any other institution in India. We also undertake that, if any information given above
is found to be false at any stage, entire amount of scholarship will be recovered and competent authority will
be free to initiate legal penal action against us.

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Page 1/2 Generated by Chhattisgarh State Scholarship Portal as on 14/1/2019

Fresh Application Government of Chhattisgarh
State Scholarship Portal 2.0
Application Form for Year 2018-19

Scheme : Post Matric SC Scholarship

Unique Applicant ID: 1120777 Application ID: 10118154

Version No: 1 Verification Code: 71045 Lock Date: 14/01/2019 IP Address : 47.247.34.230

™Ǒ‘]”‚›Ø™ɉ€ȯ]’ȡš”š†ȡğǙǓ›ȯȯ¡Ǖ]”ȡf‚™ȯȪ¡˜ȡšȣ†ȡğǙͪƣǓ“šè€š‘ȣ‡ȡȯ‚Ȣȡ†ȡğǙͪƣ€ȧǔ‡“Ȣš€˜‘ȣ‚_
¡Ȱ` ȯȡ” ›ȯ›ȣ‡ȡȯ‚Ȣ)^ š¡€ȯͩЙȡ€›ȡ” ȯ ˜ǔےͪ’ȡȸ€Ȫ¡˜ȯžȡ€ȯͧ›fͩ€ Ȣ—Ȣ™Ȫ‡“ȡ€ȯ\ۏ‚[ͩ€ Ȣ—Ȣ†ȡğǙͪƣ
 ȯͪǔ‡[
ŒȢȡš€šǑ‘™ȡ‡ȡ™ȯ‚ȡȡͪ’ȡȸ€Ȫ€ȡ›ȣ Ǘ…Ȣ
ޛȰ€ͧ›èŠ˜ɅŒȡ›Ǒ‘™ȡ‡ȡ™ȯ‚ȡȡ†ȡğǙͪƣèȢ€Ǚ€ȡ[\ͬ’€ȡšȣ\ȡ
\ۙ ¢˜\ͬ’€ȡšȣ]æ™€ ˜ˆȯ‚ɅȪ` €ȯͪǽڑ—ȡšȢ™‘ÖŒ ȲǑ¡ȡ€ȧ’ȡšȡjȲfȲ€ȯ¡
f•]_]š‘‡[€šȡ_‡ȡ€š É€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ)
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†ȡğǙͪƣžȡ “€Ȫ Ȳ–Ȳͬ’ǔ‡›ȡ€ȡ™ȡ[›™€ȯ˜ȡڙ˜ ȯ…ȡ›ȡ“ ȯȡ” €š‘Ǘȱ‚ȡ‘ǗȲ‚Ȣ)†ȡğǙͪƣȡ” “€š“ȯ€ȧǔèǓ˜Ʌžȡ “˜ȯšȯ
ͪǽƨ€Ȫ_—Ȣ€ȡ™[ȡ¡ȣ€š“ȯ€ȯͧ›™ȯ蝏Ȳğš¡ȯ‚ȡ)

(Signature of Parent / ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢šDate (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

Check List
Document to be attached : -

1. Caste Certificate issued from the competent authority

2. Residential Certificate
3. Income Certificate from the concerned authorized authority/Persons
4. H.S.C Certificate (Photo Copy) Attested by Competent authority
5. Photo Copy of the first page of Bank Passbook having account no
6. Last Year Mark Sheet

(Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

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