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    Dakhina Soren

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    Durgamadhab Jena
    The document is a scholarship application form for Dakhina Soren, a male student from Kendujhar, Odisha applying for the Post Matric Scholarship scheme for ST students. It provides his personal details like name, gender, parents' names, date of birth, annual family income, category, and contact details. It also lists the academic details of the course he is enrolled in including the name of the institution, course name, year of study, enrollment number and date, and previous academic performance.

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    Dakhina Soren

    Uploaded by

    Durgamadhab Jena
    21 views2 pages
    The document is a scholarship application form for Dakhina Soren, a male student from Kendujhar, Odisha applying for the Post Matric Scholarship scheme for ST students. It provides his personal details like name, gender, parents' names, date of birth, annual family income, category, and contact details. It also lists the academic details of the course he is enrolled in including the name of the institution, course name, year of study, enrollment number and date, and previous academic performance.

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    The document is a scholarship application form for Dakhina Soren, a male student from Kendujhar, Odisha applying for the Post Matric Scholarship scheme for ST students. It provides his personal details like name, gender, parents' names, date of birth, annual family income, category, and contact details. It also lists the academic details of the course he is enrolled in including the name of the institution, course name, year of study, enrollment number and date, and previous academic performance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views2 pages

    Dakhina Soren

    Uploaded by

    Durgamadhab Jena
    The document is a scholarship application form for Dakhina Soren, a male student from Kendujhar, Odisha applying for the Post Matric Scholarship scheme for ST students. It provides his personal details like name, gender, parents' names, date of birth, annual family income, category, and contact details. It also lists the academic details of the course he is enrolled in including the name of the institution, course name, year of study, enrollment number and date, and previous academic performance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Government of Odisha

    State Scholarship Portal


    Scholarship Application Form
    Application Number : 2225944 Fresh Application Scheme : Post Matric Scholarship-ST

    Personal Details

    Name : DAKHINA SOREN Gender : Male


    MR.ARJUN SOREN Mother's Name : SALAGE SOREN
    Father's Name :
    Annual Income : Rs.42000/- Date of Birth : 09/05/1997
    Category : ST Religion : Hindu
    Special Category : No ADHAAR Card No. : Not Available
    Caste Certificate 1457 & 12/05/2017 Caste Certficate RI
    No. & Date : Issued by :

    Academic Details
    Institute : INSTITUTE OF MANAGEMENT AND Tehsil / District : Balipatna /Khordha
    APPLICATION
    Course : Bachelor of Computer First Year Academic Year : 2017 - 18
    Application / B. C. A.
    Hosteller : Yes 10th Class Details: Orissa State Board (Annual) /2011
    /025DF026
    Hostel Admission 25/08/2017 Last Exam 51.24
    Date: Percentage:
    Enrolment No. and 48700 & 10/08/2017 Admission date for 10/08/2017
    Date : Academic year(2017
    - 18) :

    Contact Details :
    Correspondence at/po-kendua Permanent at/po-kendua
    Address ghasipura, DISTRICT :- Kendujhar Address ghasipura, DISTRICT :- Kendujhar
    (Keonjhar) , STATE :- Odisha , PIN (Keonjhar) , STATE :- Odisha , PIN
    CODE :- 758015 CODE :- 758015
    Contact Numbers : 9238541032 Email Address : dakhinasoren1997@g
    mail.com

    Bank Details :
    IFSC Code : BKID0005161
    Bank Name : BANK OF INDIA Branch Name :
    Branch Address: BARAMUNDA PLOT NO 62A HIG BDA Account Number : 516110110000996
    DUPLEX BARAMUNDA BHUBANESWAR
    DIST KHORDA ODISHA 751003

    Declaration

    Generated by Scholarship Portal as on 15/11/2017


    Government of Odisha
    State Scholarship Portal
    Scholarship Application Form
    Application Number : 2225944 Fresh Application Scheme : Post Matric Scholarship-ST

    I, DAKHINA SOREN S/o MR.ARJUN SOREN hereby declare that the information given in the application form are true as per best of
    my knowledge and belief. I also undertake that if, at any stage, it is found to the satisfaction of the sanctioning authority that the
    information given by me is false, the entire amount of scholarship will be recovered from as arrears of land revenue or any other law in
    force apart from such penal action as warranted by law. I have not applied for /in receipt of any other scholarship from Govt of
    India/Govt of Orissa.

    Check List
    Document to be attached : -

    1. Caste Certificate issued from the competent authority


    2. Residential Certificate
    3. Income Certificate from the concerned authorized authority/Persons
    4. H.S.C Certificate (Photo Copy) Attested by Competent authority
    5. Photo Copy of the first page of Bank Passbook having account no
    6. Income declaration of parents/guardian from all the sources on non-judicial stamp paper
    (Signature)

    Generated by Scholarship Portal as on 15/11/2017

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