Performa -I Performa for the eligible girls for incentive under nationla Scheme of Incentive to Girls for Secondary

Education
Distt Name Sr. No. Distt Name Block Name Name and Add fo the school Whether the school is Govt. Added Name of The Girl Father's Name D.O.B. Whether belong to Govt./ Added SC Khushbu Devi Krishna Poonam Devi Poonam Verma Brajmohan Damru Badri Prasad Late Mr. Kailash Sundarbhan Satya Narayan Asharam Ramji lal Roshan Singh Khushiram 01.07.1998 08.06.1999 08.11.1998 15.07.1998 10.07.1999 16.12.1999 01.07.1998 15.06.1999 12.10.1999 10.07.1999 SC SC SC SC SC SC SC SC SC SC ST NO NO NO NO NO NO NO NO NO NO Wether Belong to KGHV SC NO NO NO NO NO NO NO NO NO NO ST NO NO NO NO NO NO NO NO NO NO GEN NO NO NO NO NO NO NO NO NO NO

1 2 3 4 5 6 7 8 9 10

JHANSI JHANSI JHANSI JHANSI JHANSI JHANSI JHANSI JHANSI JHANSI JHANSI

BARAGOAN BARAGOAN BARAGOAN BARAGOAN BARAGOAN BARAGOAN BARAGOAN BARAGOAN BARAGOAN BARAGOAN

SHRI KRISHNA ADARSH INTER COLLEGE BARAGOAN JHANSI

ADDED

Roshni Santoshi Shivani Soniya Vandna Vinita

Certificate

Total

10

A Certificate should be recored for eath list stating that all the girls listed above unmarried. Studying in class ix in Government/Added and local school And KGBV

Signature of Nodal Officer

PERFORMA-II
Performa for abstract of number girls for Incentive under National Scheme of Incentive to Girls for Secondary Education
State : UP

Number of Schools where eligible Girls are studying Sr. No. Name of Distt. Govt. Govt Added 1 2 JHANSI 3 4 5 TOTAL Local Bodies KGBV Total

Number of eligible Girls Total

Number of eligible Girls Total Amount Required KGBV SC ST GEN 10

Govt.

Govt Added Local Bodies KGBV

Govt./Govt Aided/Local Body SC ST 10

YES

SIGNATURE OF NODAL OFFCIER

PERFORMA-III
BEN NAME Father's Name DOB CATEGARY HOME -ADD PASS KGBV ENRL SCH- NAME MMYYYY SCHTYPE DISTT NAME DISTT CODE STATE NAME STATE CODE ACCT. NO IFSC

Chapra Babaltada Jhansi Daun Baragoan Gangawali Daun Baragoan Palar Bachawli Baragoan Baragoan Bachawli

N N N N N N N N N N

13-Apr 13-Apr 13-Apr 13-Apr 13-Apr 13-Apr 13-Apr 13-Apr 13-Apr 13-Apr

SHRI KRISHNA ADARSH INTER COLLEGE BARAGOAN JHANSI

Khushbu Devi Krishna Poonam Devi Poonam Verma Roshni Santoshi Shivani Soniya Vandna Vinita

Brajmohan Damru Badri Prasad Late Mr. Kailash Sundarbhan Satya Narayan Asharam Ramji lal Roshan Singh Khushiram

01.07.1998 08.06.1999 08.11.1998 15.07.1998 10.07.1999 16.12.1999 01.07.1998 15.06.1999 12.10.1999 10.07.1999

SC SC SC SC SC SC SC SC SC SC

2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI 2 JHANSI

47 U.P. 47 U.P. 47 U.P. 47 U.P. 47 U.P. 47 U.P. 47 U.P. 47 U.P. 47 U.P. 47 U.P.

9 693310110007768 9 693310110000673 9 3315617288 9 2935001500001520 9 693310510000672 9 693210510002077 9 693310510000665 9 693210510002076 9 680160479681 9 693310110008634

BKID0006933 BKID0006933 CBIN028I501 PUNB0293500 BKID0006933 BKID0006933 BKID0006933 BKID0006933 MAHB0001428 BKID0006933

SIGNATURE OF NODAL OFFCIER