E Commerce

Topics: Academia, Chhattisgarh, Bank Pages: 2 (336 words) Published: April 18, 2013
Government of Chhattisgarh State Scholarship Portal Scholarship Application Form Application Number : 105561 Renewal Application Scheme : Post Matric SC Scholarship

Personal Details
Name : Father's Name : KAMLESH HATHILE GANGARAM HATHILE Gender : Mother's Name : Date of Birth : Religion : Male SMT. SARASWATI DEVI HATHILE 28/02/1992 Hindu

Annual Income :
Category : Special Category :

Rs.20000/SC No

Academic Details
Institute : Course : Hosteller :
Enrollment No :

Kirodimal Institute Of Tech. Garhumaria Raigarh B. E. / Mechanical Engineering No AG4775 3 Rd Year

Tehsil / District : Academic Year :
10th Class Details:

Raigarh /Raigarh 2012 - 13
State Board /2007-08 /81201984

Admission Date :


Contact Details :
Address VILL-BANDHATOLA TEH-BODLA DISTKABIRDHAM (C.G.), DISTRICT :Kabirdham , STATE :- Chhattisgarh , PIN CODE :- 491995 7509365474 Permanent Address VILL-BANDHATOLA TEH-BODLA DISTKABIRDHAM (C.G.), DISTRICT :Kabirdham , STATE :- Chhattisgarh , PIN CODE :- 491995 kamleshmrlotus@gmail .com

Contact Numbers :

Email Address :

Bank Details :
Bank Name : Branch Address: CENTRAL BANK OF INDIA CENTRAL BRANCH Branch Name : Account Number : E - PAY CARD, CG 0000003445991898

I, KAMLESH HATHILE S/o GANGARAM HATHILE hereby declare that the information given in the application form are true as per best of my knowledge and belief. I also undertake that if, at any stage, it is found to the satisfaction of the sanctioning authority that the information given by me is false, the entire amount of scholarship will be recovered from as arrears of land revenue or any other law in force apart from such penal action as warranted by law. I have not applied for /in receipt of any other scholarship from Govt of India/Govt of Chhattisgarh. Check List Document to be attached : 1. Caste Certificate issued from the competent authority 2. Residential Certificate 3. Income Certificate from the concerned...
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