GOVERNMENT OF GUJARAT Submit Date : 08/11/2022

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 222300000002030642
Students
Fresh Application

Student Basic Details

Name of Student : Patel Uru Nilesh
Name of Student (As per Aadhar) : Patel Uru Nilesh
Mother's Name : Sandhya Patel
Date of Birth : 13/02/2000 Gender : Male
Category : SEBC Religion :Hindu
Caste : Koli(Ds`Ž
Aadhaar Status Verified: Yes(06/11/2022 17:35:00)

Annual Income of Parents/Guardian/Husband (Rs): 100000 Habitation Type: Rural

Mobile Number : 9773120986 E-mail Address : urupatel135@gmail.com
Aadhar No : 54xxxxxx4435 Parent/Guardian occupation: Agriculture(EpSj
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:

Current Address: Permanant Address:

State Gujarat State Gujarat

District Surat District Valsad

Taluka Udhana Taluka Vapi

Village Village
PinCode 394210 PinCode 396191

Address:Plot no 28, first floor, gayatri society - 1, Udhana gam, Address:B-102,Raj Serenity, Rata, Via Vapi, Ta- Vapi, District-
Udhana Valsad

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 54xxxxxx4435 Bank name : -
Mandate Date : - Status :
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 02xxxxxx1496 IFSC Code : BARB0GUNJAN
Student Name(As per Bank Name): URU NILESH PATEL

Name of Bank : BANK OF BARODA

Branch Name & Address : GUNJAN

I hereby accept that
1.Details provided by me are correct to best of my knowledge
2.Shall not make any claims if amount is transferred to a wrong account due to incorrect details provided by me
3.Shall refund the amount transferred to someone else¶s account due to incorrect details provided by me
4.I will refund the excess amount credited to my account, if any.

Student Academic Details

Present Course/Class/Trade Type: Management

Present Course/Class/Trade Name : MBA (Master of Business Administration)

Present Course/Class/Trade Year : 1ST YEAR(1st Semester/2nd Semester)

Studying in : Gujarat Enrollment No:

Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 222300000002030642 Print Date :08/11/2022
 Present Institute District : Surat Present Institute : Bhagwan Mahavir College of Management (MBA)
(SFI),Vesu,Surat. 704
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : -

Enter Your Research/Thesis Subject :

Present Class Start Date : 01-Sep-2022 Present Course Completion Date : 31-May-2023

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 60000
Misc.Fee(NonRefundable Fees) 7600
Exam Fees(Rs) 2000

Total (Rs) 69600

Educational Break : No No. Of. Year in Break :

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH General B5208532 2016 73.83

11th Std/12 Std 12TH Commerce G416853 2018 65.86

Management BBA (Bachelor Of Business Administration) Finance 20180515 2022 54.4

84

Disablity Detail
Is Disability : No Type of Disability : -

Percentage of disability : - Required Guide/Coaching Guide: No

Guide Name: -
Guide Address: -

List of documents which you have attached :

1 Caste Certificate From the Competent Authorities

2 First Page Of Bank PassBook/Cancelled Cheque

3 Fee Receipt of Current Course Year

4 Self Attested Certificate of Previous academic marksheet

5 Income Certificate (Competent Authority)(Form no.16 required For Govt. Employee)

6 School Leaving Certificate (If Any)

I have read all above terms and conditions and understand them fully, I hereby declared that here I am submitting only one
application for scholarship and I haven¶t received any other scholarship/stipend or fellowship in this current session under any other
central/state government scheme. I further state that all information furnished by me is correct to my knowledge in case of any the
false information or suppression of necessary data proved in my application is liable to get cancelled at any stage of the scholarship
process and the entire amount of scholarship will be refunded by me or recovered from me. Government decision shall be final and
binding on me.

Date : 08/11/2022
Verify Mobile Number : Yes 08/11/2022
Place : Signature of the applicant
It is certified that the information filled in the above mentioned fields by the students are correct to the best of my knowledge and
all the Documents has been checked.

It is also certified that in case the applicant leaves institution or otherwise discontinues the studies or detained or accepts any other
regular scholarships/stipend/ fellowship the fact will be immediately reported to the said authority

Certified that the student is eligible for scholarship amount subject to Central/State government rules and the student is
recommended for sanction of scholarship.

Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 222300000002030642 Print Date :08/11/2022
This is to certify that student has regularly attended classes and maintained minimum attendance criteria till date for the A.Y. 2022
±2023.If student will irregular, than we will immediately reported to the said authority.

The actual School/College/University year began on __________________ and will be ended on _____________________

Signature Of Head Of The School/College/Institute/University With Official Seal

Place :
*Note : Stamp Signature will not be accepted

Date :

Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 222300000002030642 Print Date :08/11/2022