GOVERNMENT OF GUJARAT Submit Date : 09/11/2024

Application No:
PM -YASASVI Post Matric Scholarship for OBC, EBC and DNT 242500000001359538
Students
Fresh Application

Student Basic Details

Name of Student : Gosai Vyom Kaushikbhai

Name of Student (As per Aadhar) : GOSAI VYOM KAUSHIKBHAI
Mother's Name : Gosai Daxaben K
Date of Birth : 26/08/2005 Gender : Male
Category : SEBC Religion :Hindu
Caste : Gosai Fsdh: 

Aadhaar Status Verified: Yes(09/11/2024 18:13:48)

Ration Card No. : 102010000099677 Ration Card Member No. : 102010000099677004

Name As Per Ration Card: (GOSAI VYOM KAUSHIKKUMAR / Fsdh9ƥ]s\DtibDȢk\h^
EKYC Status As Per Ration Card: No EKYC Date: 01-01-1900
Aadhar Number Matched With Ration Card: No
Consent Status: I hereby give my consent to use my personal data available with food and civil supply department. I hereby give my consent to
government of Gujarat for fetching my identity for the purpose of post matric scholarship.

Annual Income of Parents/Guardian/Husband (Rs): 230000 Habitation Type: Rural

Mobile Number : 8866746688 E-mail Address : gosaivyom8@gmail.com
Aadhar No : 23xxxxxx9132 Parent/Guardian occupation: Business(V5Vs
Is Orphan: NO Day Scholar / Hosteller : Day Scholar
Marital Status : Unmarried Hostel Type:

Current Address: Permanant Address:

State Gujarat State Gujarat

District Anand District Banaskantha

Taluka Anand Taluka Deodar

Village Village
PinCode 387310 PinCode 385330

Address:11, Dahiba park society Boriavi Address:134, PURNIMA SOCIETY, NR. OLD BUS STAND, AT.
DEODAR, TA. DEODAR, DIST. BANASKANTHA

Student Bank Account Detail/Aadhar Bank Detail

I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 23xxxxxx9132 Bank name : -
NPCI Date : 11/9/2024 12:00:00 AM NPCI Status : Accept
I am giving my consent for payment of scholarship amount in my bank account, linked with Aadhar.
Account No : 43xxxxxx8781 IFSC Code : BARB0BORIAV
Student Name(As per Bank Name): GOSAI VYOM KAUSHIKBHAI

Name of Bank : BANK OF BARODA

Branch Name & Address : BORIAVI, GUJARAT

I hereby accept that
1.Details provided by me are correct to best of my knowledge

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 2.Shall not make any claims if amount is transferred to a wrong account due to incorrect details provided by me
3.Shall 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: Information Technology

Present Course/Class/Trade Name : BCA (Bachelor Of Computer Application)

Present Course/Class/Trade Year : 3RD YEAR(5th Semester/6th Semester)

Studying in : Gujarat Enrollment No: 56

Present Institute District : Anand Present Institute : Tarkesh And Niranjana Sureshbhai Patel Commerce
College, Boriavi
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : -

Enter Your Research/Thesis Subject :

Present Class Start Date : 18-Jun-2024 Present Course Completion Date : 31-Mar-2025

Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 20190
Misc.Fee(NonRefundable Fees) 610
Exam Fees(Rs) 1680

Total (Rs) 22480

Previous stream :BCA (Bachelor Of Computer Application) Previous Class/Course : 2ND YEAR(3rd Semester/4th Semester)
Previous Passing Year : 2024 Previous (%) : 50.00

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 Sanskruti vidhyalay A7166026 2020 45

11th Std/12 Std 12TH Anand high school G469968 2022 52

Disablity Detail
Is Disability : No Type of Disability : -

Percentage of disability : - Required Guide/Coaching Guide: No

Guide Name: -
Guide Address: -

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 Income Certificate (Competent Authority)(Form no.16 required For Govt. Employee)

6 School Leaving Certificate (If Any)

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.

Date : 10/11/2024

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Verify Mobile Number : Yes 09/11/2024

Place : Signature of the applicant

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. 2024
-2025. If 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 _____________________

Signature Of Head Of The School/College/Institute/University With Official Seal

Place :

*Note : Stamp Signature will not be accepted

Date :

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