Scholarship Application Form
ST&SC and MBC Welfare Department
Academic Year 2022-23
STSC92210302023965
Government of Odisha
Basic Information
Department Scheme Academic Year Application Type
ST&SC and MBC Welfare Post Matric Scholarship 2022-23 Renew in New Course
Department
Applicant Details
Applicant Name Category Applicant Gender
Ghanashyama Mahunta OBC/SEBC Male
Religion Date of Birth Aadhaar No.
Hindu 06 Oct 2004 XXXXXXXX1568
Mobile No. Alternative Mobile No. e-Mail Id
8598098794 7847808191 ghanashyamamahunta@[Link]
Father's Name Father Educational Status Father Occupational Status
Trilochan Mahunta Literate Daily Wage Earner
Mother's Name Mother Educational Status Mother Occupational Status
Ranjana Mahunta Literate House Wife
Guardian Name
--
Address Information
District Block/ULB GP/Ward
Ganjam Kabisuryanagar Paikajamuna
Village Pin Code Address
Nimundia 761104 At- NIMUNDIA, MAJHISAHI PO- PAIKA
JAMUNA, BLOCK-
KABISURYANAGAR,GANJAM.
Educational Qualification Details
For : Matric-Annual
Course Board Roll No. Passing Year Total Mark/CGPA Secured Marks/CGPA Percentage (%) Certificate
X BSE, Odisha 299DB0158 2020 600 459 76.50 Uploaded
Plus 2 CHSE, Odisha 338EA080 2022 600 446 74.33 Uploaded
Institute / Course Information (Current Education Information)
Institute District Block/ULB
Science College (Autonomous), Hinjilicut Ganjam Hinjilicut Mpl
Nature of Course Course Branch/Stream/Trade
Self Financing Bachelor of Computer Application (BCA) Bachelor of Computer Application (BCA)
Course Year (Current Year of Study) Admission/Registration No. Admission/Readmission Date
1st Year BCA22-1212 13 Oct 2021
Enrollment No. Enrollment Date
BCA22-1212 30 Aug 2022
Any Exam Conducted during current academic year? : No
Residential Status
Whether
Day Scholar
Details of Last Exam Passed
Course Course Year Passing Year
Plus 2 2nd Year 2022
Total Mark/CGPA Secured Marks/CGPA Percentage (%)
600 446 74.33
Certificate
Uploaded
Eligibility Information
Income Certificate No. Family Income To Whom the Certificate Issued
E-INC/2022/1176020 62000.00 TRILOCHAN MAHUNTA
Issuing Authority Issue Date Income Certificate
Revenue Officers not below the rank of 25 Sep 2022 Uploaded
Tahasildar / Additional Tahasildar
Matriculation Certificate No. Issuing Authority Matriculation Certificate
201468250 BSE, Odisha (Annual) Uploaded
Caste Certificate No. To Whom the Certificate Issued Issuing Authority
E-OBC/2020/46404 GHANASHYAMA MAHUNTA Revenue Officers not below the rank of
Tahasildar / Additional Tahasildar
Issue Date Caste Certificate
17 Sep 2020 Uploaded
Bank Information
Account Holder Name IFSC Code Account No.
GHANASHYAMA MAHUNTA SBIN0002073 37079007105
Whether account number tagged /seeded with
the Aadhaar number?
Yes
Bank Name Branch Name
STATE BANK OF INDIA KABISURYANAGAR
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