Directorate, Student's Welfare

THE MAHARAJA SAYAJIRAO UNIVERSITY OF BARODA

APPLICATION FORM FOR FINANCIAL ASSISTANCE/SCHOLARSHIP/FREESHIP/
FEEWAIVER FOR THE 2023-24
To,
The Registrar,
The Maharaja Sayajirao University of Baroda,
Vadodara 390002. Form No: 00000036968

Sir,

I wish to submit application form for Financial Assistance/Scholarship/Freeship/Feewaiver given below are my
details.

1. Name of the Student : DHANKAR BHUMI VISHAL

2. Place of Birth : BAHADURGARH
3. Gender : Female
4. Permanent Address : B-17 UMANAGAR SOCIETY, NEAR
NOVINO TARSALI ROAD, VADODARA
VADODARA 390009
5. Correspondence Address:B-17 UMANAGAR SOCIETY, NEAR
NOVINO TARSALI ROAD, VADODARA
VADODARA 390009

6. Contact No. : 7265856803 Others Nos. : 9824752172, 9924863414

7. Name of the Programme of Study : B.Com.(Hons.)
8. Name of the Institute / Faculty : Faculty of Commerce - Girls College
9. Fee Details of the Applicant :
CURRENT YEAR COURSE FEE (RUPEES) : 7230
Hostel Fee (Rupees) :0
10. University PRN Number: 0000008023007335
11. Aadhar Card Number: 979114234016
12. Whether admission taken under Higher Payment Program/ Regular : Regular
13. Whether ever penalized for adopting unfair means in the Examination of the University : No
14. Admission Category : Gen
14A.Wheather ever Penalised or trial for any offence under any court of Law : No
15. Have you received financial assistance under DSW Scholarship from The M.S. University : No

16. Have you received scholarship under any scheme from Goverment of Gujarat/PSU/Any other : No
17. Have you received scholarship under any scheme from private trust : No
18. Savings Bank Account Details of the Applicant
i. Bank Account No. (Savings ) : 33450100005022
ii. IFSC Code : BARB0TARSAL
iii. Name and Address of bank: : Bank Of Baroda
19. Family Income Limit : Rs. 2.26 Lakhs to 3.5 Lakhs
20. Latest Electricity Bill (Monthly) : More than Rs. 1200
21. Educational Qualification (including marks of semester examination last appeared)

Qualification Board/University Name & Address of School/College

Year of Passing Attempt Divison Mark Type %age/CPI
12th (HSC) CBSE KENDRIYA VIDYALAYA AFS MAKARPURA
2023 1 distintion %age 94.00

22. Details of the Family members (NO COLUMN IS TO BE LEFT BLANK)

Member Name Age If working, Name, Add. If retired, Annual Income

& Phone nos. of amount of income from
Employer office/ last pension other
Business being drawn Sources

Father Vishal Dhankar 43 Golden Horn Containers0Service, Bha

240000 0
Mother/ Nikita Dhankar 37 0 0 0
Guardian
23. Details of Brother's/Sister's of the applicant.

Name Qualificat- AgeWhether If working, Name, Add. Annual If Studying, Annual

ion Married & Phone nos. of income Name & Add. Fees of
Employer office of School/ School/
College College

Yash Dhankar 9th Standard14 No Saint Bas 30000

Yes
Yes
24. Details of Family Properties :
i. Total plot Area of House (Sq. ft.): 650
ii. If any floor given on rent? : No
iii. Is there any shop in the house?: No
iv. Is there any shop in the house, given on rent ? : No
v. If you have any ancestral agricultural land? : No
vi.
25. If you are living in a joint Family, give their total annual income : 0
26. If rented accommodation, address of rented accommodation and what amount of rent is being paid by
you? : NONE
27. Any other Source of Scholarship / Financial Assistance received / applied for : No
28. Details of Home Appliances :
T.V.
Motor Cycle
Fridge
 UNDERTAKING

I hereby declare that the above mentioned information furnished by me is true and correct
to the best of my knowledge and belief. If any information provided in the application form is found
incorrect at any stage or it is found that I had failed in any one or more of the Subject of the university
examinations or otherwise was ineligible to be considered for financial assistance under this scheme on
the last date of submission of application, may be rejected and amount, if any, received by me from the
university shall be refunded along with penalty, as decided by the university. This is without prejudice to
other disciplinary and other legal measures which the University may take besides the refund of the
financial assistance received. I hereby declare that no other scholarship has been availed by me.
I upload herewith my certified copies of the supporting documents as required.

1. Result with 55% overall passing marks

2. Fee Slip
3. Faculty Identity Card
4. Salary Slip of self or your parents or latest Income Certificate issued by the competent authority
of Govt. of Gujarat
5. Latest Electricity Bill of your family or residence
6. Copy of front page of your own BANK OF BARODA ( Branch within Vadodara City but
preferably University Campus Branch ) bank account passbook.
7. Disabled Identification card certified by civil surgeon (if applicable)
8. BPL Card (if applicable)
9. Rent agreement or latest rent payment receipt ( if residing on rent )
10. For Defence Certificate from competent authority(District sainik welfare & resettlement officer or
commanding officer.)
11. Death Certificate of Parents

Applicant Signature