Submit Date : 29/11/2024

Application No:
GOVERNMENT OF GUJARAT 242500000001853912

BCK-80 Instrumental Assistance For

Medical,Engineering,Diploma students(SEBC)

Fresh Application

Student Personal Details

Name of Student : Gondaliya Hardik Pratapbhai
Name of Student (As per Aadhar) : Gondaliya Hardik Pratapbhai
Mother's Name : Gondaliya Hardik Pratapbhai
Date of Birth : 15/07/2007 Gender : Male
Category : SEBC Religion :Hindu
Caste : Bawa Zhah 

Aadhaar Status Verified: Yes(29/11/2024 21:43:40)

Annual Income of Parents/Guardian/Husband (Rs): 55000 Habitation Type: Urban

Mobile Number : 9601005889 E-mail Address : [email protected]
Aadhar No : 72xxxxxx5424 Parent/Guardian occupation: Taxi Driver(N°ƈdjIh_D
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Government Hostel
Current Address: Permanant Address:
State Gujarat State Gujarat

District Bhavnagar District Porbandar

Taluka Bhavnagar City Taluka Porbandar
Village Village
PinCode PinCode 360590
Address:iti road gec boys hostel vidhyanagar bhavnagar Address:Sodhana near ram mandir 360590

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 72xxxxxx5424 Bank name : -
Mandate Date : 11/29/2024 12:00:00 AM Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 33xxxxxx1013 IFSC Code : BKID0003315
Student Name(As per Bank Name): Gondaliya Hardik Pratapbhai

Name of Bank : BANK OF INDIA

Branch Name & Address : SODHANA

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 : 1ST YEAR(1st Semester/2nd Semester)

Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 242500000001853912 Print Date :11/12/2024
 Studying in : Gujarat Enrollment No: 240210107025

Present Institute District : Bhavnagar Present Institute : GOVERNMENT ENGINEERING COLLEGE,

BHAVNAGAR 021
Admission Type : Regular Seat(Government Quota) Present Course Branch : -

Present Class Start Date : 26-Jun-2024 Present Course Completion Date : 31-May-2025

Details Of purchase Instrument

1 Drawing board 8 Set-squares.

2 Pencils(Grade HB,h and 2H) 9 Eraser or rubber

3 Compasses 10 Drwing Sheet fasteners

4 Dividers 11 Pencil sharpner
5 Protractor or circle master 12 Scientific Calculator
6 Ruler

7 French curves or flexible cords

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 C6208313 2022 75

11th Std/12 Std 12TH HSC B251553 2024 75

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 Hostel Certificate(Only For Hosteller Student)

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

7 School Leaving Certificate (If Any)

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.

Verify Mobile Number: Yes 29/11/2024

Place : Signature of the applicant

Date : 11/12/2024

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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 _____________________

Date : Signature Of Head Of The School/College/Institute/University With Official Seal

Place :

*Note : Stamp Signature will not be accepted

Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 242500000001853912 Print Date :11/12/2024