Government of Odisha

State Scholarship Portal

Scholarship Application Form For Academic Year 2019-20

Application Number : 572703 Renewal Application Scheme : Post Matric Scholarship- SC

Personal Details
Name : SWORNAPRAVA TARAI Gender : Female
SAMIRA TARAI Mother's Name : SUKANTI TARAI
Father's Name :
Annual Income : Rs.241436/- Date of Birth : 04/02/1995
Category : SC Religion : Hindu
Special Category : No ADHAAR Card No. : XXXXXXXX3652
Caste Certificate e-CAS/1616 & 30/08/2018 Caste Certficate Revenue Officer
No. & Date : Issued by :

Academic Details
Institute : Indira Gandhi National Open University Tehsil / District : Bhubaneswar /Khordha
Course : M. A. / Hindi,Second Year Academic Year : 2019-20
Hosteller : No 10th Class Details: Orissa State Board (Annual) /2011
/19RA214
Hostel Admission N.A. Last Exam 65.61
Date: Percentage:
Enrolment No. and 186074475 & 30/07/2018 Admission date for 26/05/2019
Date : Academic year
(2019-20) :

Contact Details :
Correspondence C/O - SAMIRA TARAI AT - Permanent C/O - SAMIRA TARAI AT -
Address ACHHUTADASPUR PO- JAPA, Address ACHHUTADASPUR PO- JAPA,
DISTRICT :- Jagatsinghpur , STATE :- DISTRICT :- Jagatsinghpur , STATE :-
Odisha , PIN CODE :- 754139 Odisha , PIN CODE :- 754139
Contact Numbers : , 7538072136 Email Address : swornaprava96@gmail.

Bank Details :
SBIN0008090 Branch Name : BHITHARANDHARI,
IFSC Code :
JAGATSINGHPUR
Bank Name : STATE BANK OF INDIA Account Number : *******2217
Branch Address: DIST : JAGATSINGHPUR, 754141

Declaration
I, SWORNAPRAVA TARAI S/o / D/o/ W/o/ C/o SAMIRA TARAI hereby declare that the information given in the application form is
true as per 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 me, apart from such penal action as
warranted by law. Further, I hereby consent that I have no objection in authenticating myself with Aadhaar for the purposes of availing
Post-matric Scholarship.

Check List
Document to be attached : -
a. INCOME CERTIFICATE (IN CASE YOU ARE RENEWING YOUR APPLICATION IN A NEW COURSE)
b. SELF DECLARATION OF CASTE AS GENERAL (IN CASE OF EBC STUDENT)
c. AADHAAR
d. SELF-ATTESTED CERTIFICATES/MARKSHEETS OF ALL EXAMS PASSED
e.FIRST PAGE OF BANK PASS BOOK CONTAINING THE NAME OF ACCOUNT HOLDER, ACCOUNT NUMBER, IFSC CODE.

(Signature)

Generated by Odisha Scholarship Portal as on 27/10/2019