REGISTRATION DETAILS APPLICATION ID CT201920007488467 REGISTRATION DATE 15/11/2019 APPLIED FOR SCHEME MERIT-CUM-MEANS SCHOLARSHIP FOR PROFESSIONAL AND TECHNICAL COURSES CS SCHOLARSHIP POST MATRIC/TOP STATE OF DOMICILE CHHATTISGARH CATEGORY CLASS/MCM DATE OF BIRTH NAME OF STUDENT RAFIA ANJUM 20/01/2000 (DD/MM/YYYY) GENDER FEMALE RELIGION MUSLIM COMMUNITY/CATEGORY GENERAL FATHERS NAME MOHAMMAD MOBIN ANNUAL FAMILY MOTHERS NAME SHAHNAZ BEGAM 100000 INCOME AADHAR NUMBER XXXXXXXX5541 MOBILE NUMBER 8959192979 DAY EMAIL ID ANJUMRAFIA8959@GMAIL.COM DAY SCHOLAR SCHOLAR/HOSTELER ACADEMIC DETAILS RUNGTA COLLEGE OF DENTAL COLLEGE SCIENCE AND RESEARCH KOHKA, KURUD PRESENT INSTITUTE ROAD, BHILAI (C-33006) RUNGTA COLLEGE OF DENTAL COLLEGE SCIENCE AND RESEARCH, KOHKA KURUD ROAD, BHILAIDURG, CHHATTISGARH BACHELOR OF DENTAL PRESENT CLASS/COURSE CLASS START DATE 09/09/2019 SURGERY(DENTISTRY) - 5 YEARS PRESENT YEAR 1 MODE OF STUDY REGULAR/FULL TIME CENTRAL BOARD OF SECONDARY PREVIOUS BOARD/UNIVERSITY NAME EDUCATION(CBSE) PREVIOUS HSC/INTERMEDIATE PREVIOUS PASSING 2018 CLASS/COURSE NAME [12TH]/EQUIVALENT YEAR 10TH CLASS ROLL PREVIOUS CLASS(%) 82 6151563 NO. CENTRAL BOARD OF 10TH CLASS PASSING 10TH CLASS BOARD 2018 SECONDARY YEAR NAME EDUCATION(CBSE) 12TH CLASS PASSING 12TH CLASS ROLL NO. 6652121 2016 YEAR CENTRAL BOARD OF SECONDARY 12TH CLASS BOARD NAME EDUCATION(CBSE) COMPETITIVE EXAM EXAM CONDUCTED QUALIFIED BY COMPETITIVE EXAM COMPETITIVE EXAM 0 ROLL NO YEAR ADMISSION FEE 237115 TUITION FEE 221115 MISC FEE 0 BASIC DETAILS IS ORPHAN NO IS DISABLED NO PERCENTAGE OF TYPE OF DISABILITY - - DISABILITY PARENTS MARITAL STATUS UN MARRIED OTHERS PROFESSION BANK ACCOUNT IFSC CODE UBIN0543811 438102010090189 NUMBER CONTACT DETAILS STATE CHHATTISGARH DISTRICT DURG BLOCK DURG 24F, WARD 8 FARIDNAGAR, ADDRESS PIN CODE 490023 SUPELA BHILAI
1/2 11/15/2019
SIGNATURE OF CANDIDATE SIGNATURE OF HEAD OF
SCHOOL/INSTITUTE/COLLEGE WITH STAMP ** ACCOUNT DETAILS MUST BE ENTERED CORRECT. NO MODIFICATION WILL BE ALLOWED AFTER THE FINAL SUBMISSION OF APPLICATION. *** STUDENTS ARE ADVISED TO SUBMIT ONLY ONE APPLICATION FORM. IF NSP FINDS MORE THAN ONE APPLICATION ( IN FRESH OR RENEWAL CATEGORY) OF A STUDENT, THEN ALL THE APPLICATIONS SUBMITTED BY THE STUDENT WILL BE CONSIDERED AS DUPLICATE AND WILL BE REJECTED. **** AADHAR NUMBER PROVIDED BY YOU, WILL BE AUTHENTICATED BY UIDAI AND MAY BE USED FOR PAYMENT OF SCHOLARSHIP THROUGH AADHAR PAYMENT BRIDGE(APB). ***** FOR ANY QUERY/ GRIEVANCE/ RTI, PLEASE CONTACT SCHOLARSHIP MINISTRY/DEPARTMENT/STATE.