Sambal - Application - 2023-05-06T150739.459

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èȡ¡ȰȪ]Ǔȡ ȧ¡ȡͪƭȡȡɅ Ȳ[ ȯ¡Ȱ)
ÚĤȯȡğǙͪƣȪ[
Fresh Application ǕÉȲğȢãȡ
ͧ¢ȡĤȪ× ȡ¡Ȫȡȡ]ȯ 2022-23
Applicant Unique ID: 4613295 ȪȡȡȡǕÉȲğȢãȡ
ͧ¢ȡĤȪ× ȡ¡
Application ID: 10134879 First Time Lock Date: 06/05/2023

Version No: 1 Verification Code: 3196 Lock Date: 06/05/2023 IPAddress : 49.43.42.84
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 : [16542],Govt Thakur Ranmat Singh College, Rewa District: REWA Course : B.A. (Honours)/Political Science [1235]/3rd
Year
Details Application Form 10th Board Data Samagra Data

Name PRAVEEN KUMAR BAIS Savita Devi Bais
Father Name RAMNARESH BAIS

Mother Name SAVITA BAIS
DOB 03/06/2001
Gender Male #Ǖǽ% N.A.
Category OBC #\ͪ% OBC
Applicant Samagra ID 175398088 Father's Samagra ID 127955678

Mother's Samagra ID 0
Card Holder Name Ramnaresh Bais Type of Card \ ȲǑ¢ȯğɅǓȪǔĮͧ
Ȳ
Ȫȡ
Card No. 127955678 Relation of Shramik with Applicant ͪȡ
Samagra ID as per Card 175398088
10th Board Name MP Board of Secondary 10th Board Roll No. 173536561
Education
Year of Passing 10th Board 2016-2017
Name of Entrance Examination : --

Religion : Hindu
Roll No of Entrance Examination :
Special Category : No
Common Rank in(JEE main/NEET/CLAT) :
Aadhar No. : XXXXXXXX4494
12th/10th Percentage : 75.40
I O
12th Passing Year : 2018-2019
2.Academic Details As Reported by Student : Enrollment No. : 192012870055 Admission Date :01/07/2022 I O
Details As Reported by Student

Admission Mode Direct Admission
Institute [16542],Govt Thakur Ranmat Singh College, Rewa District: REWA
Course B.A. (Honours)/Political Science [1235]/3rd Year
Academic Year 2022-23

I O
Hostel Status Non-Hosteler(Day-Scholar)
3. Total Annual Family Income : Rs.30000/-

Father/ Husband Occupation : Farmer / Agriculture, Income: 30000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
4. Contact Details Mobile No : 6267462101 PRAVEEN6267462101[AT]GMAIL[DOT]COM I O

Correspondence Address : GRAM CHANDREH DIST SIDHI, District :- SIDHI
Permanent Address : GRAM CHANDREH DIST SIDHI, District :- SIDHI
Generated by MP Scholarship Portal as on 06/05/2023

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ÚĤȯȡğǙͪƣȪ[
Fresh Application ǕÉȲğȢãȡ
ͧ¢ȡĤȪ× ȡ¡Ȫȡȡ]ȯ 2022-23
Applicant Unique ID: 4613295 ȪȡȡȡǕÉȲğȢãȡ
ͧ¢ȡĤȪ× ȡ¡
Application ID: 10134879 First Time Lock Date: 06/05/2023

Version No: 1 Verification Code: 3196 Lock Date: 06/05/2023 IPAddress : 49.43.42.84
(5. Annual Fees Claimed (Excluding Mess Caution Money ) : Rs. 10891/- I O
]ȯfȲȡȧȪȡDeclaration From Student and his Parent

We, PRAVEEN KUMAR BAIS S/o RAMNARESH BAIS and RAMNARESH BAIS hereby declare that 10th 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,
Amount Claimed, Hostel Status, College details, Course Details, Category, Card No., Card Holder Name , Relation of Shramik with Applicant
and all other information given in the application form is complete and correct. We have not submitted any other application for Mukhyamantri
Jankalyan 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.
¡PRAVEEN KUMAR BAIS S/o RAMNARESH BAIS kRAMNARESH BAIS Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡ

CBȪ[ȣ¢ȡȡ\ǕĐȡȲȪ[ȡȡȪ[ȡ[]ȡȲ Ē]_ȢĤǓȪȢȣ¢ȡ\ǕĐȡȲɅ\ȲǗǓȡ Ȣ
ȡͪ[]ȡȡfȲͪȡȡȡȧ_ȡͧȡğȡȡ ȧǔèǓȨȯͪȡɫĐͪĮȯȢȡ[ ȲÉȡȡ[ȡȡȡ
]ȯȯ ȡĮͧȡ ȲȲȡ\ÛͪǗ[fȲ ¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯǕÉȲğȢãȡȪȡfȲ\Û
ͩ ȢȪȡȯ\Ȳ[ͩ Ȣ\Û ȲèȡɅ]ȯĤèǕ¡ȣȲͩȡ¡Ȱ@\`ȪƠȡȡȣͩ ȢȢèȡ_ȡȢ¡Ȱ
Ȫ ȲǗ[ȡͧȡͪ ȣȡȯȢfȲ¡ȡȯͨȡȡǗȢȡ[ȡ¡ȣȧȡȯȢ@
Ǒ¡Øɉȡȡȣȯ]ȡȡğǙǓȯȯ¡ǕȯȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢ
ȣ_¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ȲȲͬͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢ
ȡğǙͪƣ 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 )

MMJKY 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 06/05/2023

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Application ID: 10134879 First Time Lock Date: 06/05/2023

Details Application Form 10th Board Data Samagra Data

Father Name RAMNARESH BAIS

Category OBC #\ͪ% OBC

Applicant Samagra ID 175398088 Father's Samagra ID 127955678

Name of Entrance Examination : --

Details As Reported by Student

Institute [16542],Govt Thakur Ranmat Singh College, Rewa District: REWA

Course B.A. (Honours)/Political Science [1235]/3rd Year

Academic Year 2022-23

3. Total Annual Family Income : Rs.30000/-

4. Contact Details Mobile No : 6267462101 PRAVEEN6267462101[AT]GMAIL[DOT]COM I O

Permanent Address : GRAM CHANDREH DIST SIDHI, District :- SIDHI

Generated by MP Scholarship Portal as on 06/05/2023

Application ID: 10134879 First Time Lock Date: 06/05/2023

]ȯfȲȡȧȪȡDeclaration From Student and his Parent

¡PRAVEEN KUMAR BAIS S/o RAMNARESH BAIS kRAMNARESH BAIS Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢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 06/05/2023

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Category OBC #\ͪ% OBC

]ȯfȲȡȧȪȡDeclaration From Student and his Parent

¡PRAVEEN KUMAR BAIS S/o RAMNARESH BAIS kRAMNARESH BAIS Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡ

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