GOVERNMENT OF GUJARAT Submit Date :

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 232400000001849212
Students
Fresh Application

Student Basic Details

Name of Student : Machhi Kirtan Kalpeshbhai
Name of Student (As per Aadhar) : Machhi Kirtan
Mother's Name : Bhavnaben
Date of Birth : 24/04/2004 Gender : Male
Category : SEBC Religion :Hindu
Caste : Machhi (Hindu) \hJŽ ˆeƛȳk 

Aadhaar Status Verified: Yes(15/12/2023 16:36:00)

Annual Income of Parents/Guardian/Husband (Rs): 96000 Habitation Type: Urban

Mobile Number : 8488966976 E-mail Address : kirtanmachhi3@gmail.com
Aadhar No : 63xxxxxx6294 Parent/Guardian occupation: Casual Labour ġND\ȩl^


Is Orphan: NO Day Scholar / Hosteller : Day Scholar

Marital Status : Unmarried Hostel Type:

Current Address: Permanant Address:

State Gujarat State Gujarat

District Vadodara District Vadodara

Taluka Vadodara Taluka Vadodara

Village Village
PinCode 390019 PinCode 390019

Address:b-31 sushil park society new vip road vadodara Address:C-53 SIddhivinayak Society Near super bekari New v i p
vadodara Road Vadodara Vadodara Gujarat India

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 63xxxxxx6294 Bank name : -
NPCI Date : 12/15/2023 12:00:00 AM NPCI Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 72xxxxxx1130 IFSC Code : UBIN0572471
Student Name(As per Bank Name): MACHHI KIRTAN

Name of Bank : UNION BANK OF INDIA

Branch Name & Address : NEW VIP ROAD

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: Engineering & Technology

Present Course/Class/Trade Name : B.E. (Bachelor of Engineering)

Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)

Studying in : Gujarat Enrollment No: 220503107008

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 Present Institute District : Vadodara Present Institute : SIGMA INSTITUTE OF ENGG., BAKROL 050

Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : Computer Engineering

Enter Your Research/Thesis Subject :

Present Class Start Date : 11-Jul-2023 Present Course Completion Date : 31-May-2024

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 55000
Misc.Fee(NonRefundable Fees) 1200
Exam Fees(Rs) 5000

Total (Rs) 61200

Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2023 Previous (%) : 68.50

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 10th B5158648 2019 62.15

Engineering & Technology DE (Diploma Engineering ) computer 19645030 2022 63.5

engineering 7045

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)

7 School/College Current Year Bonafide Certificate

8 Identity Card (College/School)

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 : 19/12/2023
Place : Signature of the applicant

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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.

This is to certify that student has regularly attended classes and maintained minimum attendance criteria till date for the A.Y. 2023
-2024. 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 :

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