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ABINASH

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Scholarship Application Form

ST&SC and MBC Welfare Department


Academic Year 2022-23
STSC92211242273916
Government of Odisha

Basic Information

Department Scheme Academic Year Application Type


ST&SC and MBC Welfare Post Matric Scholarship 2022-23 New
Department

Applicant Details

Applicant Name Category Applicant Gender


Abinash Das OBC/SEBC Male

Religion Date of Birth Aadhaar No.


Hindu 23 Mar 2005 (17 Year) XXXXXXXX6875
 Applicant's Aadhaar is seeded with his/her Bank Account and status is Active.

Mobile No. Alternative Mobile No. e-Mail Id


9078489517 9078489517 ad8409588@gmail.com

Father's Name Father Educational Status Father Occupational Status


Angad Kumar Das Literate Agriculture

Mother's Name Mother Educational Status Mother Occupational Status


Sanjulata Das Literate House Wife

Guardian Name Individual/ Family Information


VIEW
-- Beneficiary of NFSA

Address Information

District Block/ULB GP/Ward


Kendrapara Aul Ketupal

Village Pin Code Address


Gunudia 755061 AT-GUNUDIA, PO-ERADANGA NATARA,VIA-
GOVINDPUR KUTCHERY,ODISHA,755061

Educational Qualification Details

For : Matric-Annual

Passing Total Secured Percentage Marksheet/


Course Board Roll No. Year Mark/CGPA Marks/CGPA (%) Certificate

X BSE, Odisha 088AC0024 2020 600 245 40.83 Uploaded

Plus 2 CHSE, 143CD009 2022 600 313 52.17 Uploaded


Odisha

Institute / Course Information (Current Education Information)

Institute Type
Govt. Aided

Institute District Block/ULB


Debaray Samarsingh (Degree) College, Kendrapara Aul
Ganeswarpur
Nature of Course Course Branch/Stream/Trade
General Plus 3 Arts

Course Year (Current Year of Study) Admission/Registration No.4 Admission/Readmission Date


1st Year BA22-007 29 Oct 2022

Enrollment No. Enrollment Date


BA22-007 29 Oct 2022

Any Exam Conducted during current academic year? : No

Residential Status

Whether
Day Scholar

Details of Last Exam Passed

Course Course Year Passing Year


Plus 2 2nd Year 2022

Total Mark/CGPA Secured Marks/CGPA Percentage (%)


600 313 52.17

Certificate
Uploaded

Eligibility Information

Income Certificate No. Family Income To Whom the Certificate Issued


E-INC/2023/390784   55000.00 ANGAD KUMAR DAS

Issuing Authority Issue Date Income Certificate


Revenue Officers not below the rank of 11 Apr 2023 Uploaded
Tahasildar / Additional Tahasildar

Matriculation Certificate No. Issuing Authority Matriculation Certificate


201039651 BSE, Odisha (Annual) Uploaded

Caste Certificate No. To Whom the Certificate Issued Issuing Authority


E-SEB/2023/191015  ABINASH DAS Revenue Officers not below the rank of
Tahasildar / Additional Tahasildar

Issue Date Caste Certificate


16 Apr 2023 Uploaded

Institute Declaration Certificate


NA

Bank Information

Account Holder Name IFSC Code Account No.


ABINASH DAS IPOS0000001 040410074828

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

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