Government of Chhattisgarh

State Scholarship Portal

Scholarship Application Form
Application Number : 1471474 Fresh Application Scheme : Post Matric OBC Scholarship

Personal Details

Name : YASHPURI GOSWAMI Gender : Male

Father's Name : ARUNPURI GOSWAMI Mother's Name : YANI GOSWAMI

Annual Income : Rs.60000/- Date of Birth : 24/12/2000

Category : OBC Religion : Hindu

Aadhar No: 397633976030 Special Category : No

Academic Details
Institute : Mahant Laxmi Nara. Das College Tehsil / District : Dharsiwan /Raipur
Raipur
Course : B. Com. / Commerce 1 St Year Academic Year : 2017 - 18

Hosteller : No 10th Class Details: State Board /2015-2016 /1161820603

Enrollment No : Admission Date : 16/06/2018

Last Exam % : 63.99

Contact Details :
Correspondence Near Gajraj Pond Boriya Khurd Raipur Permanent Near Gajraj Pond Boriya Khurd Raipur
Address (c.g), DISTRICT :- Raipur , STATE :- Address (c.g), DISTRICT :- Raipur , STATE :-
Chhattisgarh , PIN CODE :- 492013 Chhattisgarh , PIN CODE :- 492013

Contact Numbers : 8962917812 Email Address : ypuri49@gmail.com

Bank Details :
Bank Name : UNITED BANK OF INDIA Branch Name : RAIPUR, RAIPUR

Branch Address: 12/101-103, MALVIYA ROAD, PO- Account Number : 0926010175036

RAIPUR, DIST-RAIPUR,
CHATTISGARH, PIN - 492001

Declaration
I, YASHPURI GOSWAMI S/o ARUNPURI GOSWAMI 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 Chhattisgarh.

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 19/11/2018