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Scholarship Application Form
ST&SC and MBC Welfare Department
Academic Year 2024-25 STSC92411236693144
Government of Odisha
Basic Information
Department Scheme Academic Year Application Type
ST&SC and MBC Welfare Post Matric Scholarship 2024-25 Renew in Same Course
Department
Applicant Details
Applicant Name Category Whether belong to PVTG
SUDAM PUTA ST No
Scheduled Tribe Name Applicant Gender
Gond Male
Religion Date of Birth OTR No.
Hindu 06 Aug 2007 (17 Year)
Aadhaar No.
XXXXXXXX2484
Bank account is seeded with Aadhaar when applied by student.
Mobile No. Alternative Mobile No. e-Mail Id
6370877347 6370877347 SudamPuta07@[Link]
Father's Name Father Educational Status Father Occupational Status
Narayana Puta Literate Self-Employed/ Business
Mother's Name Mother Educational Status Mother Occupational Status
Laxmi Puta Literate House Wife
Guardian Name Individual/ Family Information
VIEW
-- Beneficiary of NFSA
Address Information
District Block/ULB GP/Ward
Bolangir Belpara Juba
Village Pin Code Address
Juba 767025 JUBA
Educational Qualification Details
For : Matric-Annual
Passing Total Secured Percentage Marksheet/
Course Board Roll No. Year Mark/CGPA Marks/CGPA (%) Certificate
X BSE, 006EG0040 2023 600 384 64.00 Uploaded
Odisha
Institute / Course Information (Current Education Information)
Institute Type
Pvt. Unaided
Institute District Block/ULB
SAMALESWARI HIGHER SECONDARY Bolangir Patnagarh
SCHOOL
Nature of Course Course Branch/Stream/Trade
Self Financing Plus 2 Science
Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date
2nd Year IS23-075 06 Sep 2023
Enrollment No. Enrollment Date
IS23-075 06 Sep 2023
Any Exam Conducted during current academic year? : No
Residential Status
Whether
Hosteller
Date of Admission in Hostel Hostel Details No. of Months
06 Sep 2023 Residing in institution run hostel within 10
institution campus
Hosteller Bonafide Certificate
Uploaded
APAAR ID (Automated Permanent Academic Account Registry ID) Information
Do you have APAAR ID ? Reason
No
Details of Last Exam Passed
Course Passing Year Total Mark/CGPA
X 2023 600
Secured Marks/CGPA Percentage (%) Certificate
384 64.0 Uploaded
Eligibility Information
Income Certificate No. Family Income ( in Rs.) To Whom the Certificate Issued
E-INC/2024/5003319 60000.00 NARAYANA PUTA
Issuing Authority Issue Date Income Certificate
Revenue Officers not below the rank of 12 Dec 2024 Uploaded
Tahasildar / Additional Tahasildar
Matriculation Certificate No. Issuing Authority Matriculation Certificate
233422613 BSE, Odisha (Annual) Uploaded
Caste Certificate No. To Whom the Certificate Issued Issuing Authority
e-STO/2023/386338 sudam puta Revenue Officers not below the rank of
Tahasildar / Additional Tahasildar
Issue Date Caste Certificate
06 Jun 2023 Uploaded
Institute Declaration Certificate
NA
Bank Information
Account Holder Name IFSC Code Account No.
SUDAM PUTA IPOS0000001 038710046256
Whether account number tagged /seeded with
the Aadhaar number?
Yes
Bank Name Branch Name
INDIA POST PAYMENTS BANK Corporate Office, New Delhi
Passbook front page
Uploaded
Student Declaration
1. I have read and understood the conditions of award of Scholarship.
2. I am aware that my application is liable to be rejected, if it is found at any stage, that Aadhaar number provided by me is wrong or Aadhaar number is
of someone’s else.
3. I am aware that if more than one application is found, all my applications are liable to be rejected.
4. I am aware that for any wrong entry or mis-match of the Bank-account details, the State Government will not be responsible for mis-credit and I will
be held responsible for diversion of public money on this ground.
Date ........................
Place ........................
Full Signature of Applicant
