GOVERNMENT OF GUJARAT

‫ڤځښڑ‬Ḛ‫ڏ‬Ṁ‫ڀٱڤژ‬
BCK-81 Post S.S.C Scholarship For Boys(SEBC)

Renewal Application

Previous Application No: 170001705646

Previous Paid Scholarship:7433

Student Basic Details

Name of Student : Sorathiya Niraj Hiralal
Name of Student (As per Aadhar) : Niraj Hiralal Sorathiya
Mother's Name : mukta
Date of Birth : 12/05/1998 Gender : Male
Category : SEBC Religion :Hindu
Caste : Ahir Sorathia(8ˆe^ds^OŽ]h
Aadhaar Status Verified: Yes(12/12/2017 00:00:00)

Annual Income of Parents/Guardian/Husband (Rs): 29000 Habitation Type: Urban

Mobile Number : 7874535489 E-mail Address : nhsorathiya@gmail.com
Aadhar No : 28xxxxxx9907 Parent/Guardian occupation: Farm Labour(EpĂ\ȩl^
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Government Hostel

Current Address: Permanant Address:

State Gujarat State Gujarat

District Vadodara District Kachchh

Taluka Vadodara Taluka Bhuj

Village Village Nagor

PinCode 390009 PinCode 370001

Address:room no.208,government boys hostel,tarsali,vadodara Address:7-403,sorathiya society,nagor

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 28xxxxxx9907 Bank name : XXXX Bank
Mandate Date : 9/4/2015 12:00:00 AM Status : Active
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 02xxxxxx7579 IFSC Code : BARB0MSUNIV
Student Name(As per Bank Name): Niraj Hiralal Sorathiya

Name of Bank : BANK OF BARODA

Branch Name & Address : UNI. CAMPUS BRANCH

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
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.
5.I voluntarily give my consent to use my Aadhaar details
6.I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar

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 : 4TH YEAR(7th Semester/8th Semester)

Studying in : Gujarat Enrollment No:

Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 181000000000262066 Print Date :06/10/2018
 Present Institute District : Vadodara Present Institute : Facuty of Technology and Engineering (Id: C-58344)

Admission Type : TFW (Tuition Fee Wavier) Scheme Present Branch Course : Mechanical Enginnering

Enter Your Research/Thesis Subject :

Present Class Start Date : 18-Jun-2018 Present Course Completion Date : 05-May-2019

Fees Amount
Admission Fees (Rs) 8240
Tution Fees (Rs) 0
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 0

Total (Rs) 8240

Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 3RD YEAR(5th Semester/6th Semester)
Previous Passing Year : 2018 Previous (%) : 79.09

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 Gujrati C936669 2013 90.16

11th Std/12 Std 12TH Science B215645 2015 85.4

Engineering & Technology B.E. (Bachelor of Engineering) Mechanical 608098 2018 79.07

List of documents which you have attached :

1 Caste Certificate issued by Competent authorities

2 First Page Of Bank PassBook/Cancelled Cheque showing IFSC code and account no

3 Fee Receipt of Current Course Year

4 Marksheet of Previous academic last board/university examination

5 Hostel Certificate(Only For Hosteller Student)

6 Income Certificate issued by Competent Authorities

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 : 10/06/2018
Verify Mobile Number : Yes 06/10/2018

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.

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

Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 181000000000262066 Print Date :06/10/2018
Place :
*Note : Stamp Signature will not be accepted

Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 181000000000262066 Print Date :06/10/2018