Submit Date :
Application No:
GOVERNMENT OF GUJARAT 242500000001152146
VKY-157 Food Bill Assistance in College Attached Hostels
Fresh Application
Student Personal Details
Name of Student : PATEL HITAXEEBEN VASANTBHAI
Name of Student (As per Aadhar) : HITAXEEBEN VASANTBHAI PATEL
Mother's Name : DARSHNABAHEN
Date of Birth : 31/08/2005 Gender : Female
Category : ST(7ȵkɅlISKWĤiS Religion :Hindu
Caste : Dhodia QsP]h Sh}zxx{WhɆkD\TjɅkVh^s
Aadhaar Status Verified: Yes(07/11/2024 18:26:35)
Annual Income of Parents/Guardian/Husband (Rs): 247000 Habitation Type: Urban
Mobile Number : 7574980993 E-mail Address :
[email protected] Aadhar No : 64xxxxxx0674 Parent/Guardian occupation: Govt.Service(d^Dh^WsD^
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Private Hostel
Current Address: Permanant Address:
State Gujarat State Gujarat
District Navsari District Navsari
Taluka Navsari Taluka Bansda
Village Village Kamboya
PinCode PinCode 396560
Address:S S AGRAWAL COLLEGE OF NURSING, NAVSARI Address:KAMBOYA, TALAV FALIYA, TAL - VANSDA, DIST -
396445 NAVSARI
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 64xxxxxx0674 Bank name : -
Mandate Date : 11/8/2024 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 : 02xxxxxx5397 IFSC Code : BARB0RANKUV
Student Name(As per Bank Name): HITAXEEBEN VASANTBHAI PATEL
Name of Bank : BANK OF BARODA
Branch Name & Address : RANKUVA,DIST.-NAVSARI
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: Para medical
Present Course/Class/Trade Name : B.Sc(Nursing) Bachelor Of Science In Nursing
Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)
Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 242500000001152146 Print Date :08/11/2024
Studying in : Gujarat Enrollment No: 0028
Present Institute District : Navsari Present Institute : S. S. Agrawal College of Nursing Training College and
Research Centre
Admission Type : Regular Paid Seat (Self Finance) Present Course Branch : -
Present Class Start Date : 15-Oct-2024 Present Course Completion Date : 25-Oct-2025
Hostel Detail
Is Hostel run by Department No
Is Hostel attached With College Yes
Free facilities provided by Hostel? No
Previous stream :B.Sc(Nursing) Bachelor Of Science In Nursing Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2024 Previous (%) : 50.00
Are You Employed in any Organization/Establishment with leave without pay? : Not Applicable
Previous Education Detail
Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH SSC B8380100 2020 72
11th Std/12 Std 12TH SCIENCE B186558 2022 64
Para medical B.Sc(Nursing) Bachelor Of Science In Nursing 1st sem 20090 2023 70
Para medical B.Sc(Nursing) Bachelor Of Science In Nursing 2nd sem 20090 2024 71.6
Para medical B.Sc(Nursing) Bachelor Of Science In Nursing 3rd sem 20089 2024 70
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 From the Concerned Authorised Authority/Persons
6 Hostel Certificate(Only For Hosteller Student)
7 Std:12 Marksheet(If Any)
8 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.
Place : Signature of the applicant
Date : 08/11/2024
Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 242500000001152146 Print Date :08/11/2024
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 _____________________
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 242500000001152146 Print Date :08/11/2024
