(other than
caste of General Caste Category
Self-declaration for the purpose of
community) for the purpose of availing Post-matriG
STI SCI OBC/ SEBC caste/
Ambedakar Centrally Sponsored Scheme of Post-Matric
Scholarship under Dr.
(EBC) Students
Scholarships for the Economically Backward Class
Late Suresan Pradhan
BARSHA RANIPRADHAN Son /daughter of Shri
Jharsuguda Mpl district
resident of Village | town 1 city
Jharsuguda state Odisha hereby declare that I belongto
the Kulta Caste. (Indicate your sub caste) of General Caste Category (other than
ST/ SC/ OBC/ SEBC caste/ community) for the purpose of availing Post-matric Scholarship under
Dr. Ambedakar Centrally Sponsored Scheme of Post-Matric Scholarships for the Economically
Backward Class (EBC)Students.
otaykonla
Signatúrebf the Parent/Guardian Signture ofthe student
Date: |2/12/2034 Date:
a/1a/a024