Government of Odisha

State Scholarship Portal

Scholarship Application Form
Application Number : 2063726 Renewal Application Scheme : Post Matric Scholarship-ST

Personal Details

Name : Subrata PRADHAN Gender : Male

Late. NABAKISHORE PRADHAN Mother's Name : BIBHURANI PRADHAN
Father's Name :
Annual Income : Rs.97450/- Date of Birth : 01/04/1991
Category : ST Religion : Christian
Special Category : No ADHAAR Card No. : XXXXXXXX3057
Caste Certificate 158242530 & 02/02/2013 Caste Certficate TAHASILDAR TIKABALI
No. & Date : Issued by :

Academic Details
Institute : V.S.S.U.T. BURLA Tehsil / District : Sambalpur /Sambalpur
Course : M. Tech. / Civil Engineering Second Academic Year : 2018 - 19
Year
Hosteller : No 10th Class Details: ICSE Board /2008 /90055593
Hostel Admission N.A. Last Exam 65.70
Date: Percentage:
Enrolment No. and 1705030077 & 25/07/2017 Admission date for 25/07/2017
Date : Academic year(2018
- 19) :

Contact Details :
Correspondence Plot 1166 2nd phase Permanent Gudayagiri
Address Dumduma housing bord colony, Address Ps/po. Gudayagiri
DISTRICT :- Khordha , STATE :- Khandamal, DISTRICT :- Kandhamal ,
Odisha , PIN CODE :- 751019 STATE :- Odisha , PIN CODE :-
762100
Contact Numbers : Email Address :

Bank Details :
IFSC Code : SYNB0008062
Bank Name : SYNDICATE BANK Branch Name :
Branch Address: VSS UNIVERSITY OF TECHNOLOGY Account Number : 80622200014486
DIST SAMBALPUR 768017

Declaration

Generated by Scholarship Portal as on 8/10/2018

 Government of Odisha
State Scholarship Portal
Scholarship Application Form
Application Number : 2063726 Renewal Application Scheme : Post Matric Scholarship-ST

I, Subrata PRADHAN S/o Late. NABAKISHORE PRADHAN hereby declare that the information given in the application form are true
as per best of my knowledge and belief. I also undertake that if, at any stage, it is found to the satisfaction of the sanctioning authority
that the information given by me is false, the entire amount of scholarship will be recovered from as arrears of land revenue or any
other law in force apart from such penal action as warranted by law. I have not applied for /in receipt of any other scholarship from Govt
of India/Govt of Orissa.

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. Income declaration of parents/guardian from all the sources on non-judicial stamp paper
(Signature)

Generated by Scholarship Portal as on 8/10/2018