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ONLINE SCHOLARSHIP APPLICATION FORM

Karnataka Labour Welfare Board

ಸಂಘತ ಾಕರ ಮಕಂಧ ೕತಹ ಧನ ಸಾಯಾ ಅ

ST U D E N T P E R S ONA L DET A I LS

Student Name : BHOOMIKA D R Father Name : RAMKUMAR

Mother Name : RENUKA Mobile Number : 7204525843

Gender : female Graduation : Puc & equivalent courses

Present School Name : GJC GIRLS(MAIN) HASSAN


Present class/ Course : Puc
WARD-07

Present School Address : GJC GIRLS(MAIN) HASSAN WARD-07, Hassan, Student Present Address : SATHENAHALLI VILLAGE AND
Hassan POST SHANTHIGRAMA HOBLI HASSAN

Submitted On: 31 Jan, 2025 Application Year: 2024

P R E V I O U S Y E A R CL A S S A ND M A R KS

Class Name : SSLC Marks : 62 %

Marks card Copy: Submitted

SC H E D U L E D C A S T E / S CHEDUL ED T R I BES ? CER T IFIC ATE

Scheduled Caste / Scheduled Tribes : Yes Category : sc

Caste Certificate File/ Number: Submitted

INDUSTRY DETAIL

Parent / Guardian Name : RRENUKA Who is Working : mother


Relationship between student & parent : MOTHER Monthly Salary : 10000

Industry Name : M Sureshgowda, Labour Contractor, Mysore, 3rd Main 11th


Taluk : Mysuru
Cross Lalithamahalnagara Mysore 570028

District : Mysuru Pin Code : 570028

A A D H A A R C A R D DET A I L S

Aadhaar : 295987935428 Aadhaar card File : Submitted

Father's Aadhaar Number : 324089181001 Father's Aadhaar card File : Submitted

Mother's Aadhaar : 922067260820 Mother's Aadhaar card File : Submitted

BANK DETAILS

Bank name : KARNATAKA BNK LTD Branch name : KOWSHIKA

Account Type : RENUKA Account Holder name : RENUKA

Account Number : 4252500100871101 IFSC Code No : KARB0000425

Passbook Front Page Copy : Submitted

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