GOVERNMENT OF GUJARAT Submit Date : 15/11/2022

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 222300000002135320
Students
Fresh Application

Student Basic Details

Name of Student : RANA BHAVIK DASHRATHBHAI
Name of Student (As per Aadhar) : RANA BHAVIK DASHRATHBHAI
Mother's Name : REKHABEN
Date of Birth : 21/01/2001 Gender : Male
Category : SEBC Religion :Hindu
Caste : Gola-Rana(Fs_h^hRh
Aadhaar Status Verified: Yes(14/11/2022 18:36:00)

Annual Income of Parents/Guardian/Husband (Rs): 80000 Habitation Type: Rural

Mobile Number : 7383892361 E-mail Address : [email protected]
Aadhar No : 45xxxxxx7474 Parent/Guardian occupation: Agriculture(EpSj
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Private Hostel

Current Address: Permanant Address:

State Gujarat State Gujarat

District Vadodara District Mahisagar

Taluka Vaghodia Taluka Lunavada

Village Village Lunawada (M)

PinCode 391760 PinCode 389230

Address:TAGORE BHAVAN B PARUL UNIVERSITY Address:Rayfal house,Navi golwad,lunawada

VAGHODIA

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 45xxxxxx7474 Bank name : -
Mandate Date : - Status :
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 62xxxxxx0801 IFSC Code : BARB0VJLUNA
Student Name(As per Bank Name): BHAVIK DASHRATHBHAI RANA

Name of Bank : BANK OF BARODA

Branch Name & Address : OLD DENA

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.Tech (Bachelor of Technology)

Present Course/Class/Trade Year : 4TH YEAR(7th Semester/8th Semester)

Studying in : Gujarat Enrollment No: 200303109775

Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 222300000002135320 Print Date :05/01/2023
 Present Institute District : Vadodara Present Institute :
PARUL INSTITUTE OF ENGG. AND TECH.,
LIMDA, VAGHODIA 037
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : Mechanical Enginnering
Enter Your Research/Thesis Subject :
Present Class Start Date : 15-Jun-2022 Present Course Completion Date : 31-May-2023

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 95000
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 0

Total (Rs) 95000

Previous stream :B.Tech (Bachelor of Technology) Previous Class/Course : 3RD YEAR(5th Semester/6th Semester)
Previous Passing Year : 2022 Previous (%) : 71.90

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 SSC B5157836 2016 49

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)

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 : 05/01/2023
Verify Mobile Number : Yes 05/01/2023
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.

Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 222300000002135320 Print Date :05/01/2023
This is to certify that student has regularly attended online/blended education and maintained minimum attendance criteria till date
for the A.Y. 2021 ±

The actual School/College/University online/blended education 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 :

Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 222300000002135320 Print Date :05/01/2023