Ȫ \]ȪȪ_
èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡINDORE ȯ ͪ°ȡ[ãȡ Ʌ Ȳ[ ȯ¡Ȱ)
Fresh Application Backward Classes & Minorities Welfare Dept.
Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4127911 Scheme : Post Metric Scholarship for OBC
Application ID: 5908763 First Time Lock Date: 31/01/2021
Version No: 1 Verification Code: 3390 Lock Date: 31/01/2021 IPAddress : 49.36.40.112
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sign in it.
Institute : [20469],Sagar Institute of Researsh and Technology(TRUBA)(SAGE Course : B.Tech/Computer Science Engineering /1st
University) District: INDORE Year [9602]
Old Scholarship Details(Before 2014-15 No Post Metric Scholarship was sanctioned Last Year.
Details Application Form 10th Board Data Samagra Data Counselling Data
Name PRAGYA PATIDAR PRGYA PATIDAR
Father/ Husband Name CHANDRASHEKHAR
DOB 29/03/2002 28/02/2003
Gender Female[Ǒ¡ȡ%
Category OBC #\ͪ% OBC #\ͪ%
Religion : Hindu Special Category : No Voter ID : -- I O
Aadhar No. : XXXXXXXX8038
2. Details As Per Digital
Caste Certificate : Reg No: RS/434/0106/18668/2014, Name : PRAGYA, Father Name : I O
CHANDRASHEKHAR, Mother Name : MAAYA, Category : OBC, Caste : Patidar(kulambi)
3.Academic Details As Repoted by Student : Enrollment No. : 19647194 Admission Date :13/10/2020 I O
Details As Repoted by Student Counselling Details
Admission Mode Direct Admission
Institute [20469],Sagar Institute of Researsh and Technology
(TRUBA)(SAGE University) District: INDORE
Course B.Tech/Computer Science Engineering /1st Year
[9602]
Academic Year 2020-21
Hostel Admission Non-Hosteler(Day-Scholar) --
Last Year Exam Details : Exam Name: Board, Exam Date : 25/02/2020
I O
School./Institute :Morning Star School Result : Pass
School Scholarship Details Generated From Samagra Portal
Name : PRGYA PATIDAR Category : OBC DOB : XXXXXX2003 Gender : Female
Father Name : --- BPL : ¡ȣȲ CWSN : No
Sno Academic Year School Current Class
1 2019-20 Morning Star High School GORAV NAGAR RATLAM 12 th
2 2018-19 Morning Star High School GORAV NAGAR RATLAM 11 th
4. 10th Board Details 10th Board Name: C.B.S.E. Board, Year: 2018-2019, Roll No.: 1261941 I O
5. Total Annual Family Income : Rs.45000/- Income Certificate : issued by-collector ON : 30/01/2021
Father/ Husband Occupation : Farmer / Agriculture, Income: 45000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
Generated by Scholarship Portal as on 31/01/2021
Ȫ \]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡINDORE ȯ ͪ°ȡ[ãȡ Ʌ Ȳ[ ȯ¡Ȱ)
Fresh Application Backward Classes & Minorities Welfare Dept.
Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4127911 Scheme : Post Metric Scholarship for OBC
Application ID: 5908763 First Time Lock Date: 31/01/2021
Version No: 1 Verification Code: 3390 Lock Date: 31/01/2021 IPAddress : 49.36.40.112
6. Contact Details Mobile No : 8458897496 pragyapatidar108[AT]gmail[DOT]com I O
Correspondance Address : Makan N472-6 Ward N19 Ashram Road Dhonswas, District :- RATLAM
Permanent Address : Makan N472-6, Ward N19 Ashram Road Dhonswas, District :- RATLAM
7. Bank Account No: 39949131482, IFS Code: SBIN0017655, STATE BANK OF INDIA, NAMLI, RATLAM I O
8. Change History NIL I O
ALERT: Details of Applications already registered by using same Samagra ID :
Nil
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil
]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian
1. We, PRAGYA PATIDAR S/D/W/o CHANDRASHEKHAR and CHANDRASHEKHAR hereby declare that Board Roll No, Samagra ID, caste
certificate and income certificate, bank account details and all other information given in the application form is complete and correct. We have not
submitted any other application for scholarship for current academic year in any other institution in India. We also undertake that, if any information
given above is found to be false at any stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal
action against us.
¡PRAGYA PATIDAR S/D/W/o CHANDRASHEKHAR kCHANDRASHEKHAR Ȫȡȯ¡ɇ
ͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ Ē]_Ȣ¢ȡCBȪ[ȣ¢ȡȧȡ[ȢȡǓȡ]Ĥȡğɇ\ȡ`Ȳȡ\Û
ͪǗ[fȲ ¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯèȪͧȯͧfȯf¡ȣ]ȯͩȡ¡Ȱ@\`ȪƠȡȡȣȡ_
ȡȢ¡ȰȪ¡]ȯǓè¡ȪȡȯȡfȲȡͧȡͪ ȣȡȯȢfȲ¡ȡȯͨȡȡǗȢȡ[ȡ¡ȣȧȡȯȢ@
Ǒ]Øɉȯ]ȡȡğǙǓȯȯ¡Ǖ]ȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢȣ_
¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢȡğǙͪƣ
ȯͪǔ[
Ȣȡ ǑȡȡȯȡȡͪȡȸȪȡȣ Ǘ
Ȣ
ÞȰͧè ɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[\ͬȡȣ\ȡ
\Û ¢\ͬȡȣ]æ ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲȯ¡
f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧȡȯȢ)
ɇȪ [Ǘ[¡Ȫȯȯ¡ȯȪ [ ȲèȡȪ°ȯȡȯȢ¡ǗȱȪ¡ȯȣǗ[ǔàȯȡȣ¡ȪȢȧȯȯƮȡȡǗ[Ʌ ȲȲͬȪ [ȯͧȯĤȡƯ
ȡğǙͪƣȡ Ȫ ȲȲͬǔȡȡȡ[ȯȡÚ ȯ
ȡȡ ȯȡ ǗȱȡǗȲȢ)ȡğǙͪƣȡ ȯȧǔèǓɅȡ ȯȯ
ͪǽƨȪ_Ȣȡ[ȡ¡ȣȯȯͧȯèȲğ¡ȯȡ)
\ͧȡȡͪȡȯ¡èȡ¢ Date ( ]ȯȯ¡èȡ¢
Declaration from Institute Head & Institute Scholarship Nodal Officer
We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He/ She has passed last exam and is eligible
for sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His / Her attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him/ her for sanction of scholarship as per the rules. We
also undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter
to the concerned district office so that his scholarship can be put on hold. In case any information of found to be incorrect, Government will be
free to initiate action against the institute.
The institute is accredited by the Government and permission is given to conduct related course.
(Signature ) (Signature ) Date (Signature )
Scholarship Nodal Officer HOD Director/Prinicpal
Generated by Scholarship Portal as on 31/01/2021
Ȫ \]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡINDORE ȯ ͪ°ȡ[ãȡ Ʌ Ȳ[ ȯ¡Ȱ)
Fresh Application Backward Classes & Minorities Welfare Dept.
Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4127911 Scheme : Post Metric Scholarship for OBC
Application ID: 5908763 First Time Lock Date: 31/01/2021
Version No: 1 Verification Code: 3390 Lock Date: 31/01/2021 IPAddress : 49.36.40.112
Your 10th Board Details 10th
Board Name: C.B.S.E. Board,
Year: 2018-2019, Roll No.: 1261941
(Signature of Parent / ȡͪȡȯ¡èȡ¢ Date (Signature of Student / ]ȯȯ¡èȡ¢
Ȫ ȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)
Generated by Scholarship Portal as on 31/01/2021
