No My Scalrship Details

GOVERNMENT OF ANDHRA PRADESH, MINORITIES WELFARE DEPARTMENT

APPLICATION FOR STATE GOVERNMENT POST MATRIC SCHOLARSHIP FOR MINORITIES

TOKEN NUMBER

IDENTIFICATION DETAILS DATE OF RECEIPT 80716

NAME OF THE STUDENT (AS PER SSC )

SHAIK BUDDUBHAI SANDHANI

2009-07-29

DATE OF BIRTH (AS PER SSC) 1990-06-01 FATHER’S/GUARDIAN’S NAME GOUSHMOHIDDHIN GENDER

Male

PARENT/PARENT’S OCCUPATION

kooli

COMMUNITY/RELIGION

Muslim

TOTAL ANNUAL INCOME OF FAMILY

18000

APPLICATION

Renewal

SSC OR EQUIVALENT EXAM

SSC

REGISTERED NO. OF SSC/ EQUIVALENT EXAM

0460739

YEAR OF PASSING 2005 ( SSC OR EQUIVALENT EXAM)

TYPE OF RATION CARD

White

PHYSICALLY CHALLENGED

No

DETAILS OF PRESENT COURSE OF STUDY UNIVERSITY NAME

SRI VENKATESHWARA UNIVERSITY

DISTRICT WHERE COLLEGE LOCATED

NELLORE

COLLEGE NAME

GOVT. DEGREE COLLEGE, Udayagiri

COURSE NAME

Graduation

SUBJECT

B.A. GENERAL COURSES

MEDIUM OF COURSE

Telugu

PRESENT YEAR OF STUDY

2

MANDAL/TOWN/CITY WHERE COLLEGE LOCATED

UDAYAGIRI

NAME OF COMPETITIVE No EXAM

WINDOW SW1/SW2 (UNDER WHICH ADMITTED)

ENTRANCE HALL TICKET NO

ENTRANCE RANK

0

ADMISSION NO OF COLLEGE

1452

DISTANCE B/W RESIDENCE AND COLLEGE

30

CATEGORY OF ADMISSION STUDENT STATUS

DS

DETAILS OF PREVIOUS COURSE OF STUDY PREVIOUS EXAMINATION PASSED

YES

MARKS OBTAINED

637

TOTAL MARKS PERCENTAGE OF MARKS OBTAINED

BANK DETAILS NAME OF THE DISTRICT IN WHICH BANK LOCATED

NELLORE

NAME OF THE BANK

Syndicate Bank

1000 63

BRANCH

SYNB0003470

BANK ACCOUNT NO. OF THE STUDENT

3470 - 221 - 8624

PRESENT ADDRESS / ADDRESS OF CORRESPONDENCE ADDRESS STATE MANDAL/TEHSIL/TOWN/CITY EMAIL PIN CODE ASSEMBLY CONSTITUENCY

2-68, HOUSE, ROSEDAR STREET, ---------, ---------, UDAYAGIRI ANDHRA PRADESH DISTRICT NELLORE UDAYAGIRI @ UDAYAGIRI VILLAGE KONDAYAP [email protected] MOBILE NO. 9642665483 RESIDENCE PHONE 524226 8620229228 NO. UDAYAGIRI

PERMANENT ADDRESS IS SAME AS PRESENT ADDRESS

STUDY/BONAFIDE CERTIFICATE (TO BE CERTIFIED BY THEPRINCIPAL)

Photograph Attested by Principal

This is tocertify that Master/Kum._________________________________ S/O.,D/o._______________________ Resident of ___________________ Village___________________ Mandal is studying __________________ course _______ year inour College during the Academic Year __________. He/She got Admission inConvener Quota i.e. `A` Category/`B` Category/Management Quota. He/She belongsto_______ Community as per the information of the College Records and is a Dayscholar/ Hosteller. a) Bank Account No. of theCollege __________________________ b) Name of the Bank______________________________________ c) Name of the Branch_____________________________________ d) IFSC CodeNumber______________________________________ (Nationlised Banks only) Institution RecognizationNo:_________ Year:________ Valid Up to:_______ Year Date: Signature ofPrincipal (With CollegeSeal) SIGNATURE OF THE STUDENT SIGNATURE OF THEPARENT/GUARDIAN

SIGNATURE OF THEVERIFICATION OFFICER

(ASWO/ABCWO/ACWO)(OFFICE USEONLY)

DOCUMENTS TO BEENCLOSED 1. .Income Certificate issued byTahsildar. 2. Xerox copy of S.S.C orequivalent course Marks Memorandum Attested by the Principal. 3. Xerox copy of Previous Course(Class) Marks list, Attested by the Principal. 4. Bonafide Certificate issued bythe Institution. 5. Proof Of Permanent Residence(residence (Xerox copy of Ration Card/Voter ID/Electricity Bill/Gas Bill or anyother document of Father/Guardian). 6. Xerox copy of Bank A/c PassBook of the Student. 7. Photograph attested byPrincipal. 8. Details of Fee particulars andXerox copies of fee receipts. 9. Allotment Letter ofConvenor/Management Application should be sentthrough the Educational Institutions only FOR FURTHER DETAILS VISIT OURWEBSITEwww.apsmfc.com->