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èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡSHAHDOL ȯ ]Ǒȡ Ȣͪȡ ȡȡ Ʌ Ȳ[ ȯ¡Ȱ)
Fresh Application SC Development Department
Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4128149 Scheme : Post Metric Scholarship for SC
Application ID: 6279787 First Time Lock Date: 17/08/2021
Version No: 1 Verification Code: 2965 Lock Date: 17/08/2021 IPAddress : 49.35.175.39
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sign in it.
Institute : [54204],VIVEKANAND PARAMEDICAL COLLEGE District: SHAHDOL Course : B.M.L.T./BMLT/1st Year [7801]
Old Scholarship Details(Before 2014-15 No Post Metric Scholarship was sanctioned Last Year.
Details Application Form 10th Board Data Samagra Data Counselling Data
Name ARYAN CHAUDHRI ARYAN CHAOUDHARY ARYAN CHAUDHRI
Father/ Husband Name RAJU CHAUDHRI RAJU CHAOUDHARY Raju Chaudhri
DOB 01/07/2002 01/07/2002 01/07/2002
Gender Male #Ǖǽ%
Category SC #\Ǖ Ǘͬ
ȡǓ% SC #\Ǖ Ǘͬ
ȡǓ%
Religion : Hindu Special Category : No Voter ID : -- I O
Aadhar No. : XXXXXXXX0034
2. Details As Per Digital
Caste Certificate : Reg No: RS/460/0104/10712/2014, Name : ARYAN CHAUDHARI, Father I O
Name : RAJU CHAUDHARI, Mother Name : SHASHI CHAUDHARI, Category : Scheduled Caste, Caste : Chamar
3.Academic Details As Repoted by Student : Enrollment No. : app2276728 Admission Date :22/12/2020 I O
Details As Repoted by Student Counselling Details
Admission Mode Direct Admission
Institute [54204],VIVEKANAND PARAMEDICAL COLLEGE
District: SHAHDOL
Course B.M.L.T./BMLT/1st Year [7801]
Academic Year 2020-21
Hostel Admission Non-Hosteler(Day-Scholar) --
Last Year Exam Details : Exam Name: higher secondry, Exam Date : 15/05/2019
I O
School./Institute :govt h s school khannodhi Result : pass
Error: Subreport could not be shown.
4. 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2016-2017, Roll No.: 173335101 I O
5. Total Annual Family Income : Rs.30000/- Income Certificate : issued by-tahsildar ON : 01/10/2020
Father/ Husband Occupation : Private Service, Income: 30000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
6. Contact Details Mobile No : 9575426483 aryanchoudhary9575[AT]gmail[DOT]com I O
Correspondance Address : ward no 17 chormara Khannoudhi, District :- SHAHDOL
Permanent Address : , ward no 17 chormara Khannoudhi, District :- SHAHDOL
7. Bank Account No: 144701001501, IFS Code: ICIC0001447, ICICI BANK LTD, SHAHDOL, MADHYA PRADESH, I O
UMARIA
8. Change History NIL I O
Generated by Scholarship Portal as on 17/08/2021
Ȫ \]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡSHAHDOL ȯ ]Ǒȡ Ȣͪȡ ȡȡ Ʌ Ȳ[ ȯ¡Ȱ)
Fresh Application SC Development Department
Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4128149 Scheme : Post Metric Scholarship for SC
Application ID: 6279787 First Time Lock Date: 17/08/2021
Version No: 1 Verification Code: 2965 Lock Date: 17/08/2021 IPAddress : 49.35.175.39
ALERT: Details of Applications already registered by using same Samagra ID :
Nil
ALERT: Details of Applications already registered by using same 10th Board Roll No :
Nil
]ȯfȲ\ͧȡȡȧȪȡDeclaration from Student and Parent/ Guardian
1. We, ARYAN CHAUDHRI S/D/W/o RAJU CHAUDHRI and RAJU CHAUDHRI hereby declare that Board Roll No, Samagra ID, caste certificate
and income certificate, bank account details and all other information given in the application form is complete and correct. We have not submitted
any other application for scholarship for current academic year in any other institution in India. We also undertake that, if any information given above
is found to be false at any stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal action
against us.
¡ARYAN CHAUDHRI S/D/W/o RAJU CHAUDHRI kRAJU CHAUDHRI Ȫȡȯ¡ɇͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ Ē
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Ǒ]Øɉȯ]ȡȡğǙǓȯȯ¡Ǖ]ȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢȣ_
¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ ȢȢȡğǙͪƣ
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ɇȪ [Ǘ[¡Ȫȯȯ¡ȯȪ [ ȲèȡȪ°ȯȡȯȢ¡ǗȱȪ¡ȯȣǗ[ǔàȯȡȣ¡ȪȢȧȯȯƮȡȡǗ[Ʌ ȲȲͬȪ [ȯͧȯĤȡƯ
ȡğǙͪƣȡ Ȫ ȲȲͬǔȡȡȡ[ȯȡÚ ȯ
ȡȡ ȯȡ ǗȱȡǗȲȢ)ȡğǙͪƣȡ ȯȧǔèǓɅȡ ȯȯ
ͪǽƨȪ_Ȣȡ[ȡ¡ȣȯȯͧȯèȲğ¡ȯȡ)
\ͧȡȡͪȡȯ¡èȡ¢ Date ( ]ȯȯ¡èȡ¢
Declaration from Institute Head & Institute Scholarship Nodal Officer
We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He/ She has passed last exam and is eligible
for sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His / Her attendance is regular, as per the instructions of
Government
We have verified all details as per te scheme guidlelines & instructions and recommend him/ her for sanction of scholarship as per the rules. We
also undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter
to the concerned district office so that his scholarship can be put on hold. In case any information of found to be incorrect, Government will be
free to initiate action against the institute.
The institute is accredited by the Government and permission is given to conduct related course.
(Signature ) (Signature ) Date (Signature )
Scholarship Nodal Officer HOD Director/Prinicpal
Generated by Scholarship Portal as on 17/08/2021
Ȫ \]ȪȪ_ èȡ¡ȰȪ]\ȯǔȯȯȡȡ[ȯÈǔȡSHAHDOL ȯ ]Ǒȡ Ȣͪȡ ȡȡ Ʌ Ȳ[ ȯ¡Ȱ)
Fresh Application SC Development Department
Madhya Pradesh Scholarship Portal 2.0
Integrated Scholarship Application form- Post Matric Scholarships for year 2020-21
Applicant Unique ID: 4128149 Scheme : Post Metric Scholarship for SC
Application ID: 6279787 First Time Lock Date: 17/08/2021
Version No: 1 Verification Code: 2965 Lock Date: 17/08/2021 IPAddress : 49.35.175.39
Your 10th Board Details 10th
Board Name: MP Board of
Secondary Education, Year: 2016-
2017, Roll No.: 173335101
(Signature of Parent / ȡͪȡȯ¡èȡ¢ Date (Signature of Student / ]ȯȯ¡èȡ¢
Ȫ ȡğȡğȡȯ]ȯȨ[Ǒ¢ȡȢȡͪ`Þ¡ȣȲ¡Ȫȯ ȲèȡĤǕȡğȡğȡȯȢȧǗĤǓ
ȡ[Ȣ ȯ
ȡȡȣ ×ȡͪȯ)
Generated by Scholarship Portal as on 17/08/2021
