Name : AMIR HUSAIN

Father's Name : IQBAL HUSAIN

Mother's Name : MAHIRA IQBAL HUSAIN

Date of Birth : 21/12/1989

Gender :

Permanent Address :

Correspondance Address :

Male

Mobile No :

53 Ziya manzil saeediya school road Itwara Bhopal, District :- BHOPAL

53 Ziya manzil saeediya school road Itwara Bhopal, District :- BHOPAL

amirhusain2112[AT]gmail[DOT]com

Special Category : No

Institute :Course : M.E/M.Tech [Full Time]/Thermal Engineering/1Yr

Radha Raman Institute of Research, & Technology, Bhopal District: BHOPAL

10th Board Name: MP Board of Secondary Education, Year: 2005-06, Roll No.: 166339822

Enrollment No. :Admission Date : 15/08/2014

1. Personal Details

3.Academic Details

7 Contact Details

8. Bank Account

zÛɭϾ ¤Ûɰ ÒɟÙ¾ ¾ɥ ÁɨÝÌɟ , Declaration from Student and his Parent We, AMIR HUSAIN S/o IQBAL HUSAIN and IQBAL HUSAIN hereby declare that Board Roll No, Samagra ID, caste certificate and income certificate, bank account details and all other information given in the application form is complete and correct. We have not submitted any other application for scholarship for current academic year in any other institution in India. We also undertake that, if any information given above is found to be false at any stage, entire amount of scholarship will be recovered and competent authority will be free to initiate legal penal action against us. ßÖ AMIR HUSAIN S/o IQBAL HUSAIN ©Ø IQBAL HUSAIN ÁɨÝÌɟ ¾ØÍɭ ßʅ η¾ }ÒØɨǞ ÅɟѾɟØɡ Þßɡ ßɮ ¤Ûɰ ÞÖŐ z|Êɠ+ ¾àɟ `_ ÔɨÊx ÒØɡàɟ ¾ɥ Öɟ¾xÜɠÈ+ ÅɟȑÍ ÍÎɟ z× ŢÖɟÌ Òŝ+ Ôʅ¾ y¾ɟ}ɰÈ ÍÎɟ yę× θÛÛØÌ ÒȕÌx ¤Ûɰ Þßɡ ßɮ] zÛɭϾ Ñɭ ÒɨÈxÙ ÒØ {Þ Þŝ Öɭ Ħ¾ɨÙØεÜÒ ¾ɭ εÙ¤ ¾ɭÛÙ ¤¾ ßɡ zÛɭÏÑ η¾×ɟ ßɮ] yÀØ }ÒØɨǞ ÅɟѾɟØɡ ÀÙÍ Òɟ| ÅɟÍɠ ßɮ Íɨ ×ß zÛɭÏȑÑ ÑØĦÍ ßɨ ÅɟÛɭÀɟ ¤Ûɰ ØɟεÜ ÛɟθÒÞ Ùɡ ÅɟÛɭÀɠ ¤Ûɰ ßÖɟØɭ ζ¿ÙɟÓ ¾ɟÑȕÑɠ ¾ɟ×xÛɟßɡ ¾ɥ ÅɟÛɭÀɠ]

(Signature of Parent / ÒɟÙ¾ . θÒÍɟ ¾ɭ ßĦÍɟàØ ( Date (Signature of Student / zÛɭϾ ¾ɭ ßĦÍɟàØ(

Delcaration from Institute Head & Institute Scholarship Nodal Officer We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application form have been verified with the original documents and have been found to be correct and authentic. He has passed last exam and is eligible for sanction of scholarship. College has ORIGINAL COPY of his School Leaving Certificate. His attendance is regular, as per the instructions of GovernmentWe have verified all details as per te scheme guidlelines & instructions and recommend him for sanction of scholarship as per the rules.  We also undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter to the concerned district office so that his scholarship can be put on hold. In case any information of found to be incorrect, Government will be free to initiate action against the institute. (Signature of Institute Scholarship Nodal Officer) Date (Signature of Institute Director/Prinicpal)

0183ME14MT03

8871112029

6. Total Annual Family Income :

Income Certificate issued by-TEHSILDAR On : 14/10/2014

SAMAGRA ID : 131911433As per SAMAGRA: Amir Husain As Per Board Marksheet : AMIR HUSAIN

As Per Board Marksheet : IQBAL HUSAIN

As Per Board Marksheet : MANTRA IQBAL HUSAIN

As Per Board Marksheet : 21/12/1989

2.Category OBC As Per Board Marksheet : General

4. 10th Board Details

No: 21710100022210, IFS Code: BARB0KOTRAS, BANK OF BARODA, KOTRA-SULTAN-BHOPAL, BHOPAL

Religion : Muslim

Aadhaar No : 801036970569

Rs.36000/-

Caste Certificate : No: 00 Issued by :SDM HUZUR On :07/08/2008

O

O

O

O

O

O

I

I

I

I

I

I

Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute will use the first Box with I sign and Sanctioning Office will use second box with O sigh in it.

5. Last Year Exam Details : Exam Name: B TECH, Exam Date : 08/06/2012

School./Institute :SWAMI VIVEKANAND COLLEGE OF SCIENCE AND TECHNOLOGY Result : PASS

Previous Year Scholarship Details No Scholarship sanctioned last year

Hostel Admission Date: Non-Hosteler

Generated by Scholarship Portal as on 3/11/2015

Backward Classes & Minorities Welfare Dept.Madhya PradeshScholarship Portal 2.0

Integrated Scholarship Application form- Post Matric Scholarships for year

Application Number : 242539 Scheme : Post Metric Scholarship for OBC

Fresh Application

2014-15

Applicant Code : 1031875

123.63.70.189Version No: 3 Verification Code: 1960 Lock Date: 11/03/2015 IPAddress :

Nil

ALERT: Details of Applications already registered by using same 10th Board Roll No :

ALERT: Details of Applications already registered by using same Samagra ID :

Nil

Your 10th Board Details 10th Board Name: MP Board of Secondary Education, Year: 2005-06, Roll No.: 166339822

Caste Certificate Details No: 00 Issued by :SDM HUZUR On :07/08/2008

(Signature of Parent / ÒɟÙ¾ . θÒÍɟ ¾ɭ ßĦÍɟàØ ( Date (Signature of Student / zÛɭϾ ¾ɭ ßĦÍɟàØ(

Generated by Scholarship Portal as on 3/11/2015

Backward Classes & Minorities Welfare Dept.Madhya PradeshScholarship Portal 2.0

Integrated Scholarship Application form- Post Matric Scholarships for year

Application Number : 242539 Scheme : Post Metric Scholarship for OBC

Fresh Application

2014-15

Applicant Code : 1031875

123.63.70.189Version No: 3 Verification Code: 1960 Lock Date: 11/03/2015 IPAddress :