Submit Date : 16/12/2023
Application No:
GOVERNMENT OF GUJARAT 232400000001854206
BCK-79 Food Bill Assistance For Medical,Engineering Students
(SEBC)
Fresh Application
Student Personal Details
Name of Student : KAPADIYA SHIVANI HARKISHANBHAI
Name of Student (As per Aadhar) : Kapadiya Shivani
Mother's Name : Kapadiya Sonalben Harkishanbhai
Date of Birth : 11/12/2002 Gender : Female
Category : SEBC Religion :Hindu
Caste : Modh Ghanchi \sQGh5Ij
Aadhaar Status Verified: Yes(15/12/2023 23:41:00)
Annual Income of Parents/Guardian/Husband (Rs): 80000 Habitation Type: Urban
Mobile Number : 9327450210 E-mail Address : shivanimodi907@[Link]
Aadhar No : 30xxxxxx5770 Parent/Guardian occupation: Teacher(ibëDibëDh
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Private Hostel
Current Address: Permanant Address:
State Gujarat State Gujarat
District Gandhinagar District Patan
Taluka Gandhinagar Taluka Patan
Village Village
PinCode PinCode 384265
Address:[Link] College of Nursing Hostel, Civil Hospital Campus, Address:Rajkavado,Baliyapado,Charkha Sheri Na
Sector 12, Gandhinagar Nake,Mithavali Sheri,Patan.
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 30xxxxxx5770 Bank name : -
Mandate Date : 12/15/2023 12:00:00 AM Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 80xxxxxx0631 IFSC Code : BARB0DBPATG
Student Name(As per Bank Name): SHIVANI HARKISHANBHAI
KAPDIYA
Name of Bank : BANK OF BARODA
Branch Name & Address : PATAN
I hereby accept that
[Link] provided by me are correct to best of my knowledge
[Link] not make any claims if amount is transferred to a wrong account due to incorrect details provided by me
[Link] refund the amount transferred to someone else¶s account due to incorrect details provided by me
4.I will refund the excess amount credited to my account, if any.
Student Academic Details
Present Course/Class/Trade Type: Engineering & Technology
Present Course/Class/Trade Name : B.E. (Bachelor of Engineering)
Courtesy :: National Informatics Centre, Gujarat Page 1 of 3 232400000001854206 Print Date :27/10/2024
Present Course/Class/Trade Year : 4TH YEAR(7th Semester/8th Semester)
Studying in : Gujarat Enrollment No: 20BECE30063
Present Institute District : Gandhinagar Present Institute :
030 L.D.R.P. INSTITUTE OF TECH. And
RESEARCH., GANDHINAGAR (Id: C-322)
Admission Type : Regular Paid Seat (Self Finance) Present Course Branch : Computer Engineering
Present Class Start Date : 01-May-2023 Present Course Completion Date : 31-Mar-2024
Hostel Detail
Is Hostel run by Department No
Is Hostel attached With College Yes
Free facilities provided by Hostel? No
Previous stream :B.E. (Bachelor of Engineering) Previous Class/Course : 3RD YEAR(5th Semester/6th Semester)
Previous Passing Year : 2023 Previous (%) : 82.60
Educational Break : No No. Of. Year in Break :
Previous Education Detail
Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH General A1316951 2018 88.83
11th Std/12 Std 12TH Science B156468 2020 67.07
List of documents which you have attached :
1 Caste Certificate From the Competent Authorities
2 First Page Of Bank PassBook/Cancelled Cheque
3 Fee Receipt of Current Course Year
4 Self Attested Certificate of Previous academic marksheet
5 Hostel Certificate(Only For Hosteller Student)
6 Income Certificate (Competent Authority)(Form no.16 required For Govt. Employee)
7 School Leaving Certificate (If Any)
8 School/College Current Year Bonafide Certificate
9 Identity Card (College/School)
I have read all above terms and conditions and understand them fully, I hereby declared that here I am submitting only one
application for scholarship and I haven¶t received any other scholarship/stipend or fellowship in this current session under any other
central/state government scheme. I further state that all information furnished by me is correct to my knowledge in case of any the
false information or suppression of necessary data proved in my application is liable to get cancelled at any stage of the scholarship
process and the entire amount of scholarship will be refunded by me or recovered from me. Government decision shall be final and
binding on me.
Verify Mobile Number: Yes 16/12/2023
Place : Signature of the applicant
Date : 27/10/2024
Courtesy :: National Informatics Centre, Gujarat Page 2 of 3 232400000001854206 Print Date :27/10/2024
It is certified that the information filled in the above mentioned fields by the students are correct to the best of my knowledge and all
the Documents has been checked.
It is also certified that in case the applicant leaves institution or otherwise discontinues the studies or detained or accepts any other
regular scholarships/stipend/ fellowship the fact will be immediately reported to the said authority
Certified that the student is eligible for scholarship amount subject to Central/State government rules and the student is
recommended for sanction of scholarship.
This is to certify that student has regularly attended classes and maintained minimum attendance criteria till date for the A.Y. 2023
-[Link] student will irregular, than we will immediately reported to the said authority.
The actual School/College/University year began on __________________ and will be ended on _____________________
Date : Signature Of Head Of The School/College/Institute/University With Official Seal
Place :
*Note : Stamp Signature will not be accepted
Courtesy :: National Informatics Centre, Gujarat Page 3 of 3 232400000001854206 Print Date :27/10/2024