GOVERNMENT OF GUJARAT Submit Date : 10/11/2024
Application No:
Umbrella Scheme for Education of ST Students Post-Matric 242500000001395648
Scholarship
Fresh Application
Student Basic Details
Name of Student : RATHVA ANKITKUMAR GULABSINH
Name of Student (As per Aadhar) : RATHVA ANKITKUMAR
Mother's Name : JYOTIBEN
Date of Birth : 02/12/2006 Gender : Male
Category : ST(7ȵkɅlISKWĤiS Religion :Hindu
Caste : Rathawa ^hOah
Aadhaar Status Verified: Yes(10/11/2024 16:20:18)
Ration Card No. : 117009002663362 Ration Card Member No. : 117009002663362008
Name As Per Ration Card: (Rathva Ankitkumar / ^hOahӔDSȢk\h^
EKYC Status As Per Ration Card: Yes EKYC Date: 17-10-2024
Aadhar Number Matched With Ration Card: Yes
Consent Status: I hereby give my consent to use my personal data available with food and civil supply department. I hereby give my consent to
government of Gujarat for fetching my identity for the purpose of post matric scholarship.
Annual Income of Parents/Guardian/Husband (Rs): 95000 Habitation Type: Rural
Mobile Number : 6354459210 E-mail Address :
[email protected]Aadhar No : 94xxxxxx3282 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 Panchmahals District Panchmahals
Taluka Ghoghamba Taluka Ghoghamba
Village Village Ranjitnagar
PinCode 389360 PinCode 389360
Address:S/O:Gulabsinh,513,Badhava Faliyu,Ranjitnagar, Address:S/O:Gulabsinh,513,Badhava Faliyu,Ranjitnagar,
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 94xxxxxx3282 Bank name : -
NPCI Date : 11/10/2024 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 : 30xxxxxx6768 IFSC Code : BARB0BGGBXX
Student Name(As per Bank Name): ANKIT GULABSINH RATHVA
Name of Bank : BARODA GUJARAT GRAMIN BANK
Branch Name & Address : RANJITNAGAR
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
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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 OTR Details
OTR Number : OTR KYC :
Name as Per OTR :
Student Academic Details
Present Course/Class/Trade Type: Medical
Present Course/Class/Trade Name : MBBS Bachelor of Medicine and Bachelor of Surgery
Present Course/Class/Trade Year : 1ST YEAR(1st Semester/2nd Semester)
Studying in : Gujarat Enrollment No:
Present Institute District : Vadodara Present Institute : Maharaja Sayajirao University of Baroda, Vadodara
Admission Type : Regular Seat(Government Quota) Present Branch Course : -
Present Class Start Date : 14-Oct-2024 Present Course Completion Date : 30-Sep-2025
Fees Amount
Admission Fees (Rs) 4525
Tution Fees (Rs) 25000
Misc.Fee(NonRefundable Fees) 7000
Exam Fees(Rs) 1910
Total (Rs) 38435
Educational Break : No No. Of. Year in Break :
Are You Employed in any Organization/Establishment with leave without pay? : No
Previous Education Detail
Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH GENERAL A4189757 2022 82.33
11th Std/12 Std 12TH SCIENCE B229840 2024 83.08
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 From the Concerned Authorised Authority/Persons
6 Std:12 Marksheet(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.
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Date : 22/07/2025
Verify Mobile Number : Yes 17/07/2025
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.
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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