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    GOVERNMENT OF GUJARAT Submit Date : 25/10/2024

    Application No:
    PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 242500000000776568
    Students
    Fresh Application

    Student Basic Details

    Name of Student : Patel Prince Maheshbhai


    Name of Student (As per Aadhar) : Patel prince Maheshbhai
    Mother's Name : Patel sunitaben Maheshbhai
    Date of Birth : 03/04/2007 Gender : Male
    Category : EBC(8iTD^ŽSpXJhSaF½  Religion :Hindu
    Caste :
    Aadhaar Status Verified: Yes(23/10/2024 21:34:25)

    Ration Card No. : 103008012671365 Ration Card Member No. : 103008003540721010


    Name As Per Ration Card: (PATEL PRINCE MAHESHBHAI / XN°_ĭƛd\e°b[h:
    EKYC Status As Per Ration Card: No EKYC Date: 01-01-1900
    Aadhar Number Matched With Ration Card: No
    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): 67000 Habitation Type: Rural


    Mobile Number : 6352044513 E-mail Address : Krimapatel565656@gmail.com
    Aadhar No : 72xxxxxx8549 Parent/Guardian occupation: Agriculture(EpSj
    Is Orphan: NO Day Scholar / Hosteller : Day Scholar
    Marital Status : Unmarried Hostel Type:

    Current Address: Permanant Address:


    State Gujarat State Gujarat

    District Patan District Patan

    Taluka Chanasma Taluka Chanasma

    Village Village
    PinCode 384275 PinCode 384275

    Address:Vasaipura vasai patan Address:Vasaipura vasai patan

    Student Bank Account Detail/Aadhar Bank Detail


    I voluntarily give my consent to use my Aadhaar details.
    Aadhar Number : 72xxxxxx8549 Bank name : -
    NPCI Date : 10/25/2024 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 : 27xxxxxx8855 IFSC Code : UCBA0002777
    Student Name(As per Bank Name): Prince Maheshbhai Patel

    Name of Bank : UCO BANK

    Branch Name & Address : KADI


    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

    Page 1 of 3 242500000000776568 Print Date :25/10/2024


    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: Para medical

    Present Course/Class/Trade Name : B.Sc(Nursing) Bachelor Of Science In Nursing

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

    Studying in : Gujarat Enrollment No: 05925

    Present Institute District : Ahmadabad Present Institute : AHMEDABAD SCHOOL OF NURSING

    Admission Type : Regular Seat(Government Quota) Present Branch Course : -

    Enter Your Research/Thesis Subject :


    Present Class Start Date : 01-Oct-2024 Present Course Completion Date : 30-Sep-2025

    Fees Amount
    Admission Fees (Rs) 20
    Tution Fees (Rs) 0
    Misc.Fee(NonRefundable Fees) 250
    Exam Fees(Rs) 1225

    Total (Rs) 1495

    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 General A419002 2022 85.83

    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 Fee Receipt of Current Course Year

    4 Self Attested Certificate of Previous academic marksheet

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

    6 School Leaving Certificate (If Any)

    7 School/College Current Year Bonafide Certificate

    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 : 25/10/2024

    Verify Mobile Number : Yes 25/10/2024

    Place : Signature of the applicant

    Page 2 of 3 242500000000776568 Print Date :25/10/2024


    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 :

    Page 3 of 3 242500000000776568 Print Date :25/10/2024

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