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Application Form: Academic Year Institute Course Course Year Percentage Result

This document is an application form for a GOI Post Matric scholarship submitted by Kamaluddin Sherali Khan, who is applying for a Bachelor of Ayurveda, Medicine & Surgery course. It includes personal details of the applicant such as name, date of birth, family details, educational qualifications, income details, bank account information, and documents attached to support the application. The applicant is providing all relevant information needed to process the scholarship application.

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Asif Shaikh
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83 views2 pages

Application Form: Academic Year Institute Course Course Year Percentage Result

This document is an application form for a GOI Post Matric scholarship submitted by Kamaluddin Sherali Khan, who is applying for a Bachelor of Ayurveda, Medicine & Surgery course. It includes personal details of the applicant such as name, date of birth, family details, educational qualifications, income details, bank account information, and documents attached to support the application. The applicant is providing all relevant information needed to process the scholarship application.

Uploaded by

Asif Shaikh
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Form

Printed on Course 10/31/2013 7:10:33 PM Bachelor of Ayurveda, Medicine & Surgery GOI Post Matric Scholarship , 2013-2014 Other Backward Class

Application Number Appilcation type Student SSC Details SSC Board Passing Year

APPOPA1936084M200920 13 New

Renewal Course Year N.A

Please Paste Passport Size Photograph

MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION 2009 SSC Seat No OPA193608 SSC Marks Obtained 59.23

Applicant's Details Applicant Name KAMALUDDIN Date of Birth 23-08-1990 SHERALI Gender Maritial Status KHAN Male No Mother's Name SABIRA

Is Resident of Maharashtra Maharashtra Caste Category Sub Caste Other Backward Class

Application Date 31-10-2013 Caste Orphan Momin (191) No

Is Disabled Applicant's Annual Income

No 0.00

Disability Type

N.A.

Is Applicant Salaried ? NO Is Staying at Hostel ? No

Total Annual Income 55000.00 No

Has Applied For Hostel ?

Student Prequalifying Details


Academic Year Institute Course Course Year Percentage Result

2012 - 13 2011 - 12 2010 - 11

Course not Attended Course not Attended Mumbai College of Commerce 12th (Science) & Science

0 0 1

0.00 0.00 46.17

Fail Fail Pass

Institution Details Name of School/College/Institute where Admitted Course Name Course Year EID Number Subject College Adm.No 1113 Is Fees Paid ? Fee Receipt Date Contact Details No N.A Academic Year Admission Dt. Fee Paid GrantType 2013-2014 25-10-2013 0.00 Non Granted Is Admission after No Diploma Joining Date 25-10-2013 Fee Receipt No. Quota Government Quota Sangam Sevabhavi Trusts Ayurved Medical College Sangamner Ahmednagar

Bachelor of Ayurveda, Medicine & Surgery 1 CAP Number N.A UID Number 403693801430

Residential Number: , MobileNumber: 8898883870, EmailAddress: [email protected]

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Address For Correspondence Address:- PANCHASHILA NAGAR Location:- BARKAT ALI DARGA City:- WADALA Pincode:- 400037 Taluka:Mumbai District:- Mumbai Parent / Guardian Details Parent's name SHERALI MIRJA KHAN Age Profession (yrs) Service

Relation with Applicant Mother Parmanent Address Is Father Alive Hostel Information Name of Landlord / Hostel Hostel Type Hostel/ Landlord Address Is Studying in night school Document Details Caste Certificate No Caste Validity Certificate No 1284 359 District Issuing Thane Office District Issuing Thane Office Issued in 2013 No Is Mess Service Available? No

PANCHASHILA NAGAR Location:- BARKAT ALI DARGA City:- WADALA Pincode:- 400037 Taluka:- Mumbai District:- Mumbai Annual Income 55000.00 Yes

Hostel Admission Date Rent Per Month Hostel/Landlord Contact Details 0.00

Taluka Issuing Office Scrutiny Committee No University Registration No

Bhiwandi N.A N.A

Income Certificate MAG/SR/7314 No Student Bank Account Details Bank Name Branch Name IFSC Code STATE BANK OF INDIA WADALA, MUMBAI SBIN0001102

Bank Account No MICR Code

31091904623

400002085

Document Attached Caste Certificate Issued by Competant Officer Income Proof Income Certificate Issued by Competant Authority Marksheets I-card Size Photo Caste Validity Certificate SSC Mark Sheet UID document xerox Declaration The information furnished by me is complete and correct. I bear the complete responsibility for all the above information. Applicant's Signature Principal's Signature _______________________ _______________________ Applicant Parent's Signature _______________________

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