GOVERNMENT OF GUJARAT Submit Date : 10/12/2024

Application No:
Post-Matric Scholarship for girls (Having annual family income more 242500000001985595
than 2.50 Lac)(Freeship Card / Medical Loan Student Only)
Fresh Application

Student Basic Details

Name of Student : Patel Mahi Jayeshkumar

Name of Student (As per Aadhar) : PATEL MAHI JAYESHKUMAR
Mother's Name : RASHMIBEN
Date of Birth : 14/08/2007 Gender : Female
Category : ST(7ȵkɅl‡ISKWĤiS  Religion :Hindu
Caste : Tadvi SPaj 

Aadhaar Status Verified: Yes(08/12/2024 16:48:52)

Ration Card No. : 120002002089613 Ration Card Member No. : 120002002089613004

Name As Per Ration Card: (Patel Mahi Jayeshkumar / XN°_\heŽK]pbȢk\h^
EKYC Status As Per Ration Card: Yes EKYC Date: 10-11-2024
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): 2168270 Habitation Type: Urban

Mobile Number : 6354369732 E-mail Address : [email protected]
Aadhar No : 61xxxxxx1501 Parent/Guardian occupation: Doctor(‡IˆDƗdD
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 Narmada

Taluka Vadodara Taluka Nandod

Village Village Rajpipla (M)

PinCode 390021 PinCode 393145

Address:GIRLS HOSTEL, GMERS MEDICAL COLLEGE, Address:165, NAVAPARA, VISAMO KUVA VALU FALIYU,
GOTRI, CAMPUS VILL- RAJPIPLA TA- NANDOD, DIST- NARMADA

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 61xxxxxx1501 Bank name : -
NPCI Date : 12/10/2024 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 : 43xxxxxx6764 IFSC Code : SBIN0000465
Student Name(As per Bank Name): Mahi Jayeshkumar Patel

Name of Bank : STATE BANK OF INDIA

Branch Name & Address : RAJPIPLA

I hereby accept that
1.Details provided by me are correct to best of my knowledge

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 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: Medical

Present Course/Class/Trade Name : MBBS Bachelor of Medicine and Bachelor of Surgery

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

Studying in : Gujarat Enrollment No:

Present Institute District : Vadodara Present Institute : GMERS Medical College (Id: C-58352)

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

Enter Your Research/Thesis Subject :

Present Class Start Date : 14-Oct-2024 Present Course Completion Date : 13-Oct-2025

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 375000
Misc.Fee(NonRefundable Fees) 12000
Exam Fees(Rs) 5390

Total (Rs) 392390

Educational Break : No No. Of. Year in Break :

Are You Employed in any Organization/Establishment with leave without pay? : Not Applicable
Freeship Card Detail
Freeship Card No: 485
Freeship Card Issued Date: 30/08/2024
Freeship Card Issued by District:Narmada
Freeship Card Issued By Designation ID :
Name of course for which Free ship card is issued : MBBS

Indicate the details of Exemption Fees (Total Fees Amount Not Taken by
Institute/college/University) :
Admission Fee(In Rs.) : 0

Tution Fee(In Rs.) : 375000

Misc.Fee(In Rs.)(Non Refundable) : 12000

Exam Fee(In Rs.) : 5130

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH GENRAL B5319639 2022 95

11th Std/12 Std 12TH SCIENCE B313592 2024 89

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

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 3 Self Attested Certificate of Previous academic marksheet

4 Income Certificate From the Concerned Authorised Authority/Persons

5 Std:12 Marksheet(If Any)

6 Freeship Card

7 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 : 10/12/2024

Verify Mobile Number : Yes 10/12/2024

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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