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Scholarship Application Form

ST&SC and MBC Welfare Department
Academic Year 2023-24
STSC92310173001670
Government of Odisha

Basic Information

Department Scheme Academic Year Application Type

ST&SC and MBC Welfare Post Matric Scholarship 2023-24 Renew in Same Course
Department

Applicant Details

Applicant Name Category Applicant Gender

Mohit Kumar Behera OBC/SEBC Male

Religion Date of Birth Aadhaar No.

Hindu 17 Sep 2001 (22 Year) XXXXXXXX2811
 Applicant's Aadhaar is seeded with his/her Bank Account and status is Active.

Mobile No. Alternative Mobile No. e-Mail Id

6370985592 7735249367 mohitkumarbehera652@gmail.com

Father's Name Father Educational Status Father Occupational Status

Sudhakar Behera Literate Agriculture

Mother's Name Mother Educational Status Mother Occupational Status

Mamata Behera Literate House Wife

Guardian Name Individual/ Family Information

VIEW
Sudhakar Behera Beneficiary of NFSA

Address Information

District Block/ULB GP/Ward

Mayurbhanj Bangriposi Chandanpur

Village Pin Code Address

Chandanpur 757032 AT-CHANDANPUR, PO-KATRA
CHANDANPUR, PS-BANGRIPOSI

Educational Qualification Details

For : Matric-Annual

Passing Total Secured Percentage Marksheet/

Course Board Roll No. Year Mark/CGPA Marks/CGPA (%) Certificate

X BSE, Odisha 313CD0022 2017 600 447 74.50 Uploaded

Plus 2 CHSE, Odisha 310KA086 2019 600 336 56.00 Uploaded

Plus 3 Fakirmohan 5747B19007 2022 1800 1380 76.67 Uploaded

University

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Institute / Course Information (Current Education Information)

Institute Type
Pvt. Unaided

Institute District Block/ULB

Seemanta Engineering College (SEC), Mayurbhanj Saraskana
Mayurbhanj

Nature of Course Course Branch/Stream/Trade

General Master in Computer Application (MCA) Master in Computer Application (MCA)

Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date

2nd Year 2322MCA03 06 Jul 2023

Enrollment No. Enrollment Date

2322MCA03 09 Nov 2022

Any Exam Conducted during current academic year? : Yes

Exam Type Total Mark/CGPA Secured Mark/CGPA Percentage (%)

1st Semester/Periodic 10 8 76.00

Residential Status

Whether
Day Scholar

Details of Last Exam Passed

Course Course Year Passing Year

Master in Computer Application (MCA) 1st Year 2023

Total Mark/CGPA Secured Marks/CGPA Percentage (%)

10 8 76.0

Certificate
Uploaded

Eligibility Information

Income Certificate No. Family Income (in Rs.) To Whom the Certificate Issued
E-INC/2023/717738   65000.00 SUDHAKAR BEHERA

Issuing Authority Issue Date Income Certificate

Revenue Officers not below the rank of 12 Jun 2023 Uploaded
Tahasildar / Additional Tahasildar

Matriculation Certificate No. Issuing Authority Matriculation Certificate

1701265401 BSE, Odisha (Annual) Uploaded

Caste Certificate No. To Whom the Certificate Issued Issuing Authority

E-SEB/2023/521869  MOHIT KUMAR BEHERA Revenue Officers not below the rank of
Tahasildar / Additional Tahasildar

Issue Date Caste Certificate

05 Oct 2023 Uploaded

Institute Declaration Certificate

NA

Divyang Disability Percentage Issuing Authority

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NA -- --

Issue Date Special Category Certificate

NA

Bank Information

Account Holder Name IFSC Code Account No.

Mr. Mohit Kumar Behera SBIN0006127 41221873515

Whether account number tagged /seeded with

the Aadhaar number?
Yes

Bank Name Branch Name

STATE BANK OF INDIA JHARPOKHARIA

Passbook front page

Uploaded

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Student Declaration

1. I have read and understood the conditions of award of Scholarship.

2. I am aware that my application is liable to be rejected, if it is found at any stage, that Aadhaar number provided by me is wrong or Aadhaar number is of
someone’s else.
3. I am aware that if more than one application is found, all my applications are liable to be rejected.
4. I am aware that for any wrong entry or mis-match of the Bank-account details, the State Government will not be responsible for mis-credit and I will be
held responsible for diversion of public money on this ground.
Date ........................
Place ........................

Full Signature of Applicant

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