GOVERNMENT OF GUJARAT Submit Date : 22/10/2024

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 242500000000416683
Students
Renewal Application

Previous Application No: 232400000000463260

Previous Paid Scholarship:

Student Basic Details

Name of Student : Patel Laykumar Ravindra
Name of Student (As per Aadhar) : Laykumar Ravindrabhai Patel
Mother's Name : SUDHA
Date of Birth : 21/04/2004 Gender : Male
Category : SEBC Religion :Hindu
Caste : Koli Ds`Ž 

Aadhaar Status Verified: Yes(18/10/2024 18:38:05)

Annual Income of Parents/Guardian/Husband (Rs): 40000 Habitation Type: Rural

Mobile Number : 9727430897 E-mail Address : [email protected]
Aadhar No : 34xxxxxx1996 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 Valsad District Valsad

Taluka Umbergaon Taluka Umbergaon

Village Sanjan Village Sanjan

PinCode 396150 PinCode 396150

Address:380, Koliwad, Sanjan Bhilad Road, Sanjan Address:380, Koliwad, Sanjan Bhilad Road, Sanjan

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 34xxxxxx1996 Bank name : -
NPCI Date : 10/22/2024 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 : 02xxxxxx6558 IFSC Code : BARB0SANJAN
Student Name(As per Bank Name): Laykumar Ravindrabhai Patel

Name of Bank : BANK OF BARODA

Branch Name & Address : SANJAN, DIST VALSAD

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: Engineering & Technology

Present Course/Class/Trade Name : B.E. (Bachelor of Engineering)

Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)

Studying in : Gujarat Enrollment No: 220860131028

Present Institute District : Valsad Present Institute : Laxmi Institute of Technology, Valsad 086

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 Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : Computer Science & Engineering

Enter Your Research/Thesis Subject :

Present Class Start Date : 27-Jun-2024 Present Course Completion Date : 30-May-2025

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 72000
Misc.Fee(NonRefundable Fees) 0
Exam Fees(Rs) 2000

Total (Rs) 74000

Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2024 Previous (%) : 68.80

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 A140677 2020 80.8

11th Std/12 Std 12TH SCIENCE M034466 2022 62.5

Engineering & Technology B.E. (Bachelor of Engineering) COMPUTER COMPUT 2023 74.5
SCIENCE & ER
ENGINEERING SCIENCE
&E
Engineering & Technology B.E. (Bachelor of Engineering) COMPUTER 22086013 2024 68.8
SCIENCE & 1028
ENGINEERING

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 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 : 22/10/2024
Verify Mobile Number : Yes 22/10/2024
Place : Signature of the applicant

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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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