GOVERNMENT OF GUJARAT Submit Date :

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 242500000000538144
Students
Fresh Application

Student Basic Details

Name of Student : KUKADIYA HARSHADBHAI KALUBHAI

Name of Student (As per Aadhar) : Kukadiya harshad Kalubhai
Mother's Name : SHILPABEN
Date of Birth : 09/07/2006 Gender : Male
Category : SEBC Religion :Hindu
Caste : Talapada Koli S`XUhDs`Ž 

Aadhaar Status Verified: Yes(01/11/2024 14:41:36)

Ration Card No. : 114003005531252 Ration Card Member No. : 114003005531252004

Name As Per Ration Card: (Kukadiya Harshad Kalubhai / ȢkDˆP]hec½UDhį[h9
EKYC Status As Per Ration Card: Yes EKYC Date: 29-10-2024
Aadhar Number Matched With Ration Card: Yes
Consent Status: I hereby give my consent to use my personal data available with food and civil supply department. I hereby give my consent to
government of Gujarat for fetching my identity for the purpose of post matric scholarship.

Annual Income of Parents/Guardian/Husband (Rs): 70000 Habitation Type: Rural

Mobile Number : 9099963661 E-mail Address : harshadkukadiya41@gmail.com
Aadhar No : 79xxxxxx0376 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 Botad District Botad

Taluka Gadhada Taluka Gadhada

Village Derala Village Derala

PinCode 364750 PinCode 364750

Address:AT:- DERALA Address:AT:- DERALA

TA:- GADHADA TA:- GADHADA
DIS:- BOTAD DIS:- BOTAD

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 79xxxxxx0376 Bank name : -
NPCI Date : 11/9/2024 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 : 91xxxxxx4980 IFSC Code : BARB0DBGADA
Student Name(As per Bank Name): HARSHADBHAI KALUBHAI
KUKADIYA
Name of Bank : BANK OF BARODA

Branch Name & Address : Gadhada (Swamina )

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 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: Information Technology

Present Course/Class/Trade Name : BCA (Bachelor Of Computer Application)

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

Studying in : Gujarat Enrollment No:

Present Institute District : Rajkot Present Institute :

T.N.RAO INSTITUTE OF MANAGEMENT
RESEARCH And TECHNOLOGY And B.ED.COLLEGE-RAJKOT
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : -
Enter Your Research/Thesis Subject :
Present Class Start Date : 01-Jul-2024 Present Course Completion Date : 30-May-2025

Fees Amount
Admission Fees (Rs) 100
Tution Fees (Rs) 30000
Misc.Fee(NonRefundable Fees) 250
Exam Fees(Rs) 1450

Total (Rs) 31800

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 C6225509 2022 74.83

11th Std/12 Std 12TH Arts G 499913 2024 84.43

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.

Page 2 of 3 242500000000538144 Print Date :09/11/2024

Date : 09/11/2024

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.

This is to certify that student has regularly attended classes and maintained minimum attendance criteria till date for the A.Y. 2024
-2025. 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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