Medhavi Applicant Form

Ȫ\]ȪȪ_ èȡ¡ȰȪ]Ǔȡ ȧèȡ ȢȨȣȯǔÈ¡ȡͪƭȡɅ Ȳ[ ȯ¡Ȱ)
Department of Technical Education & Skill Development

Madhya Pradesh Scholarship Portal 2.0
Fresh Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2019-20
Applicant Unique ID: 3500231 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10203737
First Time Lock Date: 17/09/2019
Version No: 1 Verification Code: 2636 Lock Date: 17/09/2019 IPAddress : 49.36.25.10
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sign in it.
Institute : [51062],Rani Durgavati University, Jabalpur District: JABALPUR Course : B.A. L.L.B./Law with Arts/1st Year [1264]
Details Application Form Name of Entrance Examination : --

Name SHREYANSH PANDEY Roll No of Entrance Examination :
Father Name SANJEEV Common Rank in(JEE main/NEFT/CLAT) :
DOB 20/09/2001 12th Percentage : 93.40
Gender Male #Ǖǽ% 12th Passing Year : 2018-2019
Category GENERAL # ȡȡÛ%
Religion : Hindu Special Category : No I O

Aadhar No. : XXXXXXXX5423
2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O
3.Academic Details As Reported by Student : Enrollment No. : Admission Date :30/07/2019 I O
Details As Reported by Student

Admission Mode Centralized Counselling
Institute [51062],Rani Durgavati University, Jabalpur District: JABALPUR
Course B.A. L.L.B./Law with Arts/1st Year [1264]
Academic Year 2019-20

I O
Hostel Admission Non-Hosteler(Day-Scholar)
4. Total Annual Family Income : Rs.350000/-

Father/ Husband Occupation : Private Service, Income: 350000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
5. Contact Details Mobile No : 9425547338 SHREYANSHP737[AT]GMAIL[DOT]COM I O

Correspondence Address : 4/1 KHINNI BASTI KACHHPURA MAL GODAMWARD -19KAMLA NEHRU WARD, District :-
JABALPUR
Permanent Address : 4/1 KHINNI BASTI KACHHPURA MAL GODAMWARD -19KAMLA NEHRU WARD, District :-
JABALPUR
6. Bank Account No: , IFS Code: , , , I O
7. Annual Fees Claimed(Rs.) 20000/- I O
8. Additional Scholarships Amount Claimed by the Student :

8.1 MMVY BENEFIT amount already PAID for the academic year : Rs. /-on date: I O
Additional Scholarship Amount Claimed for this acadmic year 2019-20 : Rs.20000/-
Justification for Additional claim as provided by student:
Generated by MP Scholarship Portal as on 25/01/2020

Ȫ\]ȪȪ_ èȡ¡ȰȪ]Ǔȡ ȧèȡ ȢȨȣȯǔÈ¡ȡͪƭȡɅ Ȳ[ ȯ¡Ȱ)
Department of Technical Education & Skill Development

Madhya Pradesh Scholarship Portal 2.0
Fresh Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2019-20
Applicant Unique ID: 3500231 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10203737
First Time Lock Date: 17/09/2019
Version No: 1 Verification Code: 2636 Lock Date: 17/09/2019 IPAddress : 49.36.25.10
]ȯfȲȡȧȪȡDeclaration From Student and his Parent
We, SHREYANSH PANDEY S/o SANJEEV and SANJEEV hereby declare that 12th Board Roll No, Board Name, Board Year, Aadhaar No,
SAMAGRA ID, Entrance Exam Roll No, Rank, Marks, Domicile, Annual Income and occupation details of father and Mother, Bank account
details, Amount Claimed, Hostel Status, College detils, Course Details, Category and all other information given in the application form is complete
and correct. We have not submitted any other application for Mukhyamantri Medhavi Vidharthi Yojna or any other scheme that offer the
reimbursement of fee for current academic year in any other institution. 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 Director, Technical Education Dept, Government of Madhya Pradesh will be free to
register FIR and initiate legal penal action and against us.
¡SHREYANSH PANDEY S/o SANJEEV kSANJEEV Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[ȣ¢ȡȡ

\ǕĐȡȲ]ȡȲĤǓȪȢȣ¢ȡ\ǕĐȡȲɅ\ȲǗǓȡ Ȣȡͪ[]ɇ\ȡ`Ȳȡ\ÛͪǗ[fȲ ¡ȣ¡Ȱ@
]ȯȯȪ[^ ğȯǕÉȲğȢȯȡȢͪÚȡȸȪȡfȲ\Ûͩ Ȣ\ÛȪȡȯ\Ȳ[ͩ Ȣ\Û ȲèȡɅ]ȯ
ĤèǕ¡ȣȲͩȡ¡Ȱ@\`ȪƠȡȡȣͩ ȢȢèȡ_ȡȢ¡ȰȪ ȲǗ[ȡͧȡͪ ȣȡȯȢfȲ¡ȡȯͨȡȡǗȢ
ȡ[ȡ¡ȣȧȡȯȢ@
Ǒ¡Øɉȡȡȣȯ]ȡȡğǙǓȯȯ¡ǕȯȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢ
ȣ_¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ Ȣ
ȢȡğǙͪƣ ȯͪǔ[
ȢȡǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ
ÞȰͧèɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[
\ͬȡȣ\ȡ\Û ¢\ͬȡȣ]æ ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲ
ȯ¡f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧȡȯȢ)
Date (Signature of Parent / ȡͪȡȯ¡èȡ¢(Signature of Student / ]ȯȯ¡èȡ¢
Declaration from Institute Head & Institute Scholarship Nodal Officer

We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He/She is eligible for sanction of
scholarship. College has ORIGINAL COPY of his School Leaving Certificate. He is attending regular Classes, as per the instructions of Government
We have verified all details as per the scheme guidelines & instructions and recommend him for sanction of scholarship as per the rules. We also
undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter to the
Director, Technical Education so that his scholarship can be put on hold. In case any information found to be incorrect, Government will be free to
initiate action against the institute.
The institute is accredited by the Government and permission is given to conduct related course.
Date (Signature ) (Signature ) (Signature )

MMVY Scheme Incharge HOD Director/Principal
Ȫȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)
Generated by MP Scholarship Portal as on 25/01/2020

Medhavi Applicant Form

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Medhavi Applicant Form

Uploaded by

Copyright:

Available Formats

Ȫ\]ȪȪ_ èȡ¡ȰȪ]Ǔȡ ȧèȡ ȢȨȣȯǔÈ¡ȡͪƭȡɅ Ȳ[ ȯ¡Ȱ)

Department of Technical Education & Skill Development

Applicant Unique ID: 3500231 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Details Application Form Name of Entrance Examination : --

Religion : Hindu Special Category : No I O

2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O

3.Academic Details As Reported by Student : Enrollment No. : Admission Date :30/07/2019 I O

Details As Reported by Student

Institute [51062],Rani Durgavati University, Jabalpur District: JABALPUR

Course B.A. L.L.B./Law with Arts/1st Year [1264]

Academic Year 2019-20

4. Total Annual Family Income : Rs.350000/-

5. Contact Details Mobile No : 9425547338 SHREYANSHP737[AT]GMAIL[DOT]COM I O

6. Bank Account No: , IFS Code: , , , I O

7. Annual Fees Claimed(Rs.) 20000/- I O

8. Additional Scholarships Amount Claimed by the Student :

Generated by MP Scholarship Portal as on 25/01/2020

Department of Technical Education & Skill Development

Applicant Unique ID: 3500231 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

¡SHREYANSH PANDEY S/o SANJEEV kSANJEEV Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[ȣ¢ȡȡ

Date (Signature of Parent / ȡͪȡȯ¡èȡ¢ (Signature of Student / ]ȯȯ¡èȡ¢

Declaration from Institute Head & Institute Scholarship Nodal Officer

Date (Signature ) (Signature ) (Signature )

Generated by MP Scholarship Portal as on 25/01/2020

You might also like

Ȫ\]ȪȪ_ èȡ¡ȰȪ]Ǔȡ ȧèȡ ȢȨȣȯǔÈ¡ȡͪƭȡɅ Ȳ[ ȯ¡Ȱ)

¡SHREYANSH PANDEY S/o SANJEEV kSANJEEV Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[ȣ¢ȡȡ

Date (Signature of Parent / ȡͪȡȯ¡èȡ¢(Signature of Student / ]ȯȯ¡èȡ¢