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    Scholarship Application Form: Basic Information

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    Siba Rao
    K. Sibarama Rao, a 17-year-old male from Ganjam district, has applied for a junior merit scholarship for the 2022-23 academic year to continue his Class 11 and 12 education. He is currently studying in the 2nd year of commerce at Chidananda Saraswati Higher Secondary School in Digapahandi block. His family income is Rs. 45,000 per year. He has submitted documents including Aadhaar, income, residence certificates and bank details to verify his eligibility for the scholarship. He has declared that he understands the scholarship conditions and is aware his application could be rejected if any information is found to be incorrect.

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    Scholarship Application Form: Basic Information

    Uploaded by

    Siba Rao
    154 views3 pages
    K. Sibarama Rao, a 17-year-old male from Ganjam district, has applied for a junior merit scholarship for the 2022-23 academic year to continue his Class 11 and 12 education. He is currently studying in the 2nd year of commerce at Chidananda Saraswati Higher Secondary School in Digapahandi block. His family income is Rs. 45,000 per year. He has submitted documents including Aadhaar, income, residence certificates and bank details to verify his eligibility for the scholarship. He has declared that he understands the scholarship conditions and is aware his application could be rejected if any information is found to be incorrect.

    Original Title

    s Me 542210271940299

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    K. Sibarama Rao, a 17-year-old male from Ganjam district, has applied for a junior merit scholarship for the 2022-23 academic year to continue his Class 11 and 12 education. He is currently studying in the 2nd year of commerce at Chidananda Saraswati Higher Secondary School in Digapahandi block. His family income is Rs. 45,000 per year. He has submitted documents including Aadhaar, income, residence certificates and bank details to verify his eligibility for the scholarship. He has declared that he understands the scholarship conditions and is aware his application could be rejected if any information is found to be incorrect.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    154 views3 pages

    Scholarship Application Form: Basic Information

    Uploaded by

    Siba Rao
    K. Sibarama Rao, a 17-year-old male from Ganjam district, has applied for a junior merit scholarship for the 2022-23 academic year to continue his Class 11 and 12 education. He is currently studying in the 2nd year of commerce at Chidananda Saraswati Higher Secondary School in Digapahandi block. His family income is Rs. 45,000 per year. He has submitted documents including Aadhaar, income, residence certificates and bank details to verify his eligibility for the scholarship. He has declared that he understands the scholarship conditions and is aware his application could be rejected if any information is found to be incorrect.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Scholarship Application Form

    School & Mass Education Department


    Academic Year 2022-23
    SME542210271940299
    Government of Odisha

    Basic Information

    Department Scheme Academic Year Application Type


    School & Mass Education Junior Merit (Class - 11 to 12) 2022-23 Renew in Same Course
    Department

    Unique Ref. No. (CAF Barcode)


    NA

    Applicant Details

    Applicant Name Category Applicant Gender


    K.Sibarama Rao General Male

    Religion Date of Birth Aadhaar No.


    Hindu 08 Mar 2005 (17 Year) XXXXXXXX2967

    Mobile No. Alternative Mobile No. e-Mail Id


    9556648493 9348805500 sibarao780@gmail.com

    Father's Name Mother's Name Guardian Name


    K Ananda Rao K Mamita K Ananda Rao

    Address Information

    District Block/ULB GP/Ward


    Ganjam Digapahandi Gaudagam

    Village Pin Code Address


    Dauni 761011 AT/PO-DAUNI, PS - NUAGAON

    Educational Qualification Details

    Passing Total Secured Percentage Marksheet/


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

    X BSE, 411DB0098 2021 600 414 69.00 Uploaded


    Odisha

    Institute / Course Information (Current Education Information)

    Institute District Block/ULB


    Chidananda Saraswati Higher Secondary Ganjam Digapahandi
    School, Bamkoi

    Nature of Course Course Branch/Stream/Trade


    General Plus 2 Commerce

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


    2nd Year IC21-006 05 Jul 2022

    Details of Last Exam Passed

    Course Passing Year Total Mark/CGPA


    X 2021 600
    Secured Marks/CGPA Percentage (%) Certificate
    414 69.0 Uploaded

    Eligibility Information

    Income Certificate No. Family Income To Whom the Certificate Issued


    E-INC/2021/497417   45000.00 K.Ananda rao

    Issuing Authority Issue Date Income Certificate


    Revenue Officers not below the rank of 07 Aug 2021 Uploaded
    Tahasildar / Additional Tahasildar

    Residence Certificate No. To Whom the Certificate Issued Issuing Authority


    e-RES/2021/678588  null Revenue Officers not below the rank of
    Tahasildar / Additional Tahasildar

    Issue Date Residence Certificate


    07 Aug 2021 Uploaded

    Regd. No. on College ID Card College ID Card Cover Page


    06 Uploaded

    Bank Information

    Account Holder Name IFSC Code Account No.


    K SIBARAM RAO SBIN0010911 38199988137

    Whether account number tagged /seeded with


    the Aadhaar number?
    Yes

    Bank Name Branch Name


    STATE BANK OF INDIA DIGAPAHANDI

    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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