Mukhyamantri Yuva Swavalamban Yojana

Education Department,Gujarat State

Sahay Renewal Application Form.
Application Id :111479
2019 (2nd Renewal ) Scholarship Year:2019
Application Lock Date: 20-09-2019
Candidate Details :
Name : PATEL FERIN RAKESHKUMAR
ID:1H117B512699

Date of Birth : 09-12-1999 Aadhaar card number: ********9420 Category : General

Bpl card no:0 Bpl score: - Gender : Male
Family Annual Income (Rs.) : 454421 Ration card number : 0
E-mail : ferinpatel79@gmail.com Mobile No. : 9106054633
Bank Name :Dena Bank Bank Savings A/C no : 109210035825

Bank Branch : vishalnagar branch, SURAT

IFSC Code : BKDN0231092

HSC Details : Board : Gujarat Board Stream : Science Seat No. : B512699

Percentile :91.37 Percentage :0.00

Admission Details : Enrollment number:170090107033

University : GUJARAT TECHNOLOGICAL UNIVERSITY Institute Type:Self Financed
Programme : ENGINEERING Exam System:Semester
Course : COMPUTER ENGINEERING Result System :SPI
Institute : C. K. PITHAWALLA COLLEGE OF ENG. & TECHNOLOGY, SURAT

2019 (2nd Renewal ) Details Previous year attendance more than 75%:Yes

Yearly tution fees (Rs.):79000 Any disciplinary action taken?: No

Tution fee sahay received:41000 Hostel-food sahay received:0 Book equipment sahay received:5000
Previous year percentage (Average) : 83.15 Previous year sahay received (Rs.) :46000

Documents:
Fee Receipt Income Certificate from Competent Authority (Mamlatdar
Income Tax Return for F.Y. respective to renewal year / TDO)

Sahay Renewal Certificate from Head Of Institute(in Original) First page print of savings account passbook (with IFS
code)
Last Even Semester University Marksheet
Aadhaar Card
Pan card (Father)
Last Odd Semester University Marksheet

Declaration:
I hereby declare that all the particulars provided by me is true and correct. In the event of suppression or distortion
of any information provided by me, I understand that my application for availing scholarship is liable for cancellation.I
accept and understand all rules and regulations of Mukhyamantri Yuva Swavalamban Yojana and it is abide to me.I also
give permission for use of my Aadhaar number details for authentication, DBT purpose etc.

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(Signature Of Student) (Signature Of Parent)