SC Development Department: Fresh Application

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Fresh Application SC Development Department

Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4136679 Scheme : Post Metric Scholarship for SC
Application ID: 6278770 First Time Lock Date: 16/08/2021
Version No: 1 Verification Code: 4195 Lock Date: 16/08/2021 IPAddress : 157.34.205.249
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 : [54204],VIVEKANAND PARAMEDICAL COLLEGE District: SHAHDOL Course : B.M.L.T./BMLT/1st Year [7801]
Old Scholarship Details(Before 2014-15 No Post Metric Scholarship was sanctioned Last Year.
Details Application Form 10th Board Data Samagra Data Counselling Data
Name SUNITA AHIRWAR SUNITA AHIRWAR SUNITA AHIRWAR
Father/ Husband Name RAMSUFAL AHIRWAR RAMSUFAL AHIRWAR Ramsufal Ahirwar
DOB 15/07/2002 15/07/2002 15/07/2002

Gender Female[Ǒ¡ȡ%
Category SC #\Ǖ ǗͬȡǓ% SC #\Ǖ ǗͬȡǓ%
Religion : Hindu Special Category : No Voter ID : -- I O

Aadhar No. : XXXXXXXX6320
2. Details As Per Digital

Caste Certificate : Reg No: RS/460/0104/36815/2014, Name : SUNEETA AHIRWAR, Father I O
Name : RAMSUPHAL AHIRWAR, Mother Name : SUMEELA AHIRWAR, Category : Scheduled Caste, Caste : Ahirwar
3.Academic Details As Repoted by Student : Enrollment No. : app21278457 Admission Date :04/09/2020 I O
Details As Repoted by Student Counselling Details

Admission Mode Direct Admission
Institute [54204],VIVEKANAND PARAMEDICAL COLLEGE

District: SHAHDOL
Course B.M.L.T./BMLT/1st Year [7801]
Academic Year 2020-21
Hostel Admission Non-Hosteler(Day-Scholar) --
Last Year Exam Details : Exam Name: hogher secondry, Exam Date : 27/07/2020
I O
School./Institute :govt h s school gohparu shahdol Result : pass
Error: Subreport could not be shown.
4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2016-2017, Roll No.: 173334625 I O
5. Total Annual Family Income : Rs.40000/- Income Certificate : issued by-tahsildar ON : 07/08/2019
Father/ Husband Occupation : Private Service, Income: 40000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
6. Contact Details Mobile No : 9301823919 ahisunita20202020[AT]gmail[DOT]com I O

Correspondance Address : Word no. 3 Gram - Khamha Post - Bareli Bareli, District :- SHAHDOL
Permanent Address : Word no. 3, Gram - Khamha Post - Bareli Bareli, District :- SHAHDOL
7. Bank Account No: 144701001494, IFS Code: ICIC0001447, ICICI BANK LTD, SHAHDOL, MADHYA PRADESH, I O
UMARIA
8. Change History NIL I O
Generated by Scholarship Portal as on 16/08/2021

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ALERT: Details of Applications already registered by using same Samagra ID :
Nil
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil
]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian

1. We, SUNITA AHIRWAR S/D/W/o RAMSUFAL AHIRWAR and RAMSUFAL AHIRWAR hereby declare that Board Roll No, Samagra ID, 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.
¡SUNITA AHIRWAR S/D/W/o RAMSUFAL AHIRWAR kRAMSUFAL AHIRWAR Ȫȡȯ¡ɇ
ͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ Ē]_Ȣ¢ȡCBȪ[ȣ¢ȡȧȡ[ȢȡǓȡ]Ĥȡğɇ\ȡ`Ȳȡ\Û
ͪǗ[fȲ ¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯèȪͧȯͧfȯf¡ȣ]ȯͩȡ¡Ȱ@\`ȪƠȡȡȣȡ_
ȡȢ¡ȰȪ¡]ȯǓè¡ȪȡȯȡfȲȡͧȡͪ ȣȡȯȢfȲ¡ȡȯͨȡȡǗȢȡ[ȡ¡ȣȧȡȯȢ@
Ǒ]Øɉȯ]ȡȡğǙǓȯȯ¡Ǖ]ȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢȣ_
¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢȡğǙͪƣ
ȯͪǔ[
ȢȡǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ
ÞȰͧèɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[\ͬȡȣ\ȡ
\Û ¢\ͬȡȣ]æ ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲȯ¡
f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧȡȯȢ)
ɇȪ [Ǘ[¡Ȫȯȯ¡ȯȪ [ ȲèȡȪ°ȯȡȯȢ¡ǗȱȪ¡ȯȣǗ[ǔàȯȡȣ¡ȪȢȧȯȯƮȡȡǗ[Ʌ ȲȲͬȪ [ȯͧȯĤȡƯ
ȡğǙͪƣȡ Ȫ ȲȲͬǔȡȡȡ[ȯȡÚ ȯȡȡ ȯȡ ǗȱȡǗȲȢ)ȡğǙͪƣȡ ȯȧǔèǓɅȡ ȯȯ
ͪǽƨȪ_Ȣȡ[ȡ¡ȣȯȯͧȯèȲğ¡ȯȡ)
\ͧȡȡͪȡȯ¡èȡ¢Date ( ]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 has passed last exam and is eligible
for sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His / Her attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him/ her 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 concerned district office so that his scholarship can be put on hold. In case any information of 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.
(Signature ) (Signature ) Date (Signature )

Scholarship Nodal Officer HOD Director/Prinicpal

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Your 10th Board Details 10th

Board Name: MP Board of
Secondary Education, Year: 2016-
2017, Roll No.: 173334625
(Signature of Parent / ȡͪȡȯ¡èȡ¢Date (Signature of Student / ]ȯȯ¡èȡ¢
Ȫȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)

SC Development Department: Fresh Application

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Fresh Application SC Development Department

Father/ Husband Name RAMSUFAL AHIRWAR RAMSUFAL AHIRWAR Ramsufal Ahirwar

DOB 15/07/2002 15/07/2002 15/07/2002

Religion : Hindu Special Category : No Voter ID : -- I O

2. Details As Per Digital

Details As Repoted by Student Counselling Details

Institute [54204],VIVEKANAND PARAMEDICAL COLLEGE

Academic Year 2020-21

Hostel Admission Non-Hosteler(Day-Scholar) --

6. Contact Details Mobile No : 9301823919 ahisunita20202020[AT]gmail[DOT]com I O

8. Change History NIL I O

Generated by Scholarship Portal as on 16/08/2021

Fresh Application SC Development Department

]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian

\ͧȡȡͪȡȯ¡èȡ¢ Date ( ]ȯȯ¡èȡ¢

(Signature ) (Signature ) Date (Signature )

Generated by Scholarship Portal as on 16/08/2021

Fresh Application SC Development Department

Your 10th Board Details 10th

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

Generated by Scholarship Portal as on 16/08/2021

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]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian

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