sc / sca / st (fresh)
Post on 18-Dec-2021
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SC / SCA / ST (Fresh) Date:…./…../20……
Roll No Scholarship ID
Course Branch Year
Name of the Student
Name of the Father
Date of Birth 19 Gender MALE / FEMALE
Religion Hindu / Muslim / Christian First Graduate YES / NO
Community (as per community certificate)
BC MBC DNC SC ST Caste
Annual Income (as per Income Certificate)
Email ID
Aadhar Card No
Communication Address:
………………………………………………………………….…………
………………………...….………………………………………………
Taluk…………………………..District………………………..PinCode
Student Mobile No. Parent Mobile No
Bank Account Details of the Student
Student Bank Account Number
MICR Code (9 digit code)
IFSC Code (11 digit code)
Hosteller YES / NO Date of Joining at the Hostel (Current academic Year)
Signature of Warden
with seal (if Hosteller) Signature of the Student
Signature of Head of Department
SCHOLARSHIP ONLINE REGISTRATION APPLICATION FORM
Name of the Bank Branch Name
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