GOVERNMENT OF GUJARAT Submit Date :

Application No:
(BCk-6.1) Post Matric Scholarship for SC students (Government of 242500000001447457
India Scheme)(Freeship Card Student Only)
Fresh Application

Student Basic Details

Name of Student : Parmar Pragatiben Vinodkumar

Name of Student (As per Aadhar) : Parmar Pragatiben Vinodbhai
Mother's Name : MANJULABEN
Date of Birth : 14/06/1997 Gender : Female
Category : SC(7ȵkɅl‡ISĤiS  Religion :Hindu
Caste : Hindu Vankar ˆeƛȳkaRD^ 

Aadhaar Status Verified: Yes(05/12/2024 18:50:40)

Ration Card No. : 302007005175807 Ration Card Member No. : 102007005175807003

Name As Per Ration Card: (Parmar Pragatiben Vinodbhai / X^\h^̆FSjZpWiaWsU[h9
EKYC Status As Per Ration Card: Yes EKYC Date: 04-10-2024
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): 60000 Habitation Type: Rural

Mobile Number : 7284067738 E-mail Address : [email protected]
Aadhar No : 92xxxxxx3435 Parent/Guardian occupation: Labour(\ȩl^Ž
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:

Current Address: Permanant Address:

State Gujarat State Gujarat

District Banaskantha District Banaskantha

Taluka Vadgam Taluka Vadgam

Village Memadpur Village Memadpur

PinCode 385421 PinCode 385421

Address:AT POST MEMADPUR Address:AT POST MEMADPUR

TA VADGAM TA VADGAM
DIST BANASKANTHA DIST BANASKANTHA
PIN 385421 PIN 385421

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 92xxxxxx3435 Bank name : -
NPCI Date : 12/7/2024 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 : 01xxxxxx5253 IFSC Code : BARB0VADGAM
Student Name(As per Bank Name): PRAGATIBEN VINODBHAI
PARMAR
Name of Bank : BANK OF BARODA

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Branch Name & Address : VADGAM DIST BANASKANTHA
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: Education

Present Course/Class/Trade Name : MEd (Master Of Education)

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

Studying in : Gujarat Enrollment No: NEW ADMISSION

Present Institute District : Banaskantha Present Institute : SMT R.K.D. KHUNUSHIYA MED COLLEGE,
PALANPUR
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : -

Enter Your Research/Thesis Subject :

Present Class Start Date : 15-Aug-2024 Present Course Completion Date : 30-Apr-2025

Fees Amount
Admission Fees (Rs) 100
Tution Fees (Rs) 60000
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 900

Total (Rs) 61000

Educational Break : Yes No. Of. Year in Break : 1

Freeship Card Detail

Freeship Card No: 431
Freeship Card Issued Date: 22/08/2024
Freeship Card Issued by District:Banaskantha

Previous Education Detail

Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH GSHSEB A 263530 2012 62.8

11th Std/12 Std 12TH GSHSEB G 141638 2014 51.14

Education B.Ed. (Bachelor of Education) HNGU PATAN 00579 2022 85.5

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 Income Certificate (Competent Authority)(Form no.16 required For Govt. Employee)

4 Std:10 Marksheet

5 Other Marksheets/Last Year Marksheet (If Any)

6 Freeship Card

7 Identity Card (College/School)

Page 2 of 3 242500000001447457 Print Date :07/12/2024

 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 : 07/12/2024

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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