8/10/2019 Csss-renewal [F-11] Scholarship Form

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10/26/2014 CSSS-RENEWAL [F-11] Scholarship Form

http://122.180.127.140/2014/csssrenew/renewconfpage.aspx

To,The Assistant Secretary (Scholarship),7th Floor, CBSE, Shiksha Kendra,2, Community Centre, Preet Vihar, Delhi-110092

Form No.:Registration No. of CSS ScholarshipClass XII Roll No.Year of Passing

R20131005961300512166296842013

Signature of candidat

Signature with Stamp Of Head of the Institution _______________________________

Name & Designation _______________________________

Tel. & Mobile No. _______________________________

Email ID: _______________________________

Seal

CENTRAL BOARD OF SECONDARY EDUCATIONSHIKSHA KENDRA, 2, COMMUNITY CENTRE, PREET VIHAR, DELHI-110092

CSS SCHOLARSHIP - 1 RENEWAL OF YEAR 2013 FORM: F-11

1.Applicant Name:UPENDRA KUMAR SAHUFather's/Guardian's Name:S L SAHU CategoryODOB20/04/1996 Gender M

2. How much amount received till date against the CSSS award: 10000

3. Address of theInstitution :

NATIONAL INSTITUTE OF TECHNOLOGY, RAIPUR (C.G),Raipur, Chhatisgarh, Email:

Type ofInstitution :

Central Govt

Have you changed theCollege/Institution of Study

NO

Name of the Institution where courseis being pursued:

NITRAIPU

4. Have you changed the Stream/Course of Study NO

Name of the Current Course & Duration : B.TECH Duration:4Years

Subject of the Course : UG DEGREE

Type of Programme : ENGINEERING

Mode of Study : REGULAR MODE

Pattern of Examination : SEMESTER

Course Approval : AICTE

5. Aggregate marks obtained in Annual Examination first/second/third year (which is applicable) (if result is in grades,equivalent percentage is required from the college/university)

77

6. Address for Correspondence: QR. 29/C, STREET-36, SECTOR-04

BHILAI NAGAR

Durg, ChhatisgarhPin: 490001

Telephone

No. with STDCode: (0788)2224791

Mobile No.: 9424121652

E-mail ID: somesh70fdy0905@gmail.co

7 Is the candidate in receipt of any other scholarship from State Governmentor other institution or person ?

No

8 Adhaar Card/Enrollment Number of Applicant (Optional)

9. Particulars of Savings Bank Account of Applicant

a) Account Number 33276062151

b) Name of the Bank STATE BANK OF INDIA

c) Address of the Bank INDIRA PLACE BHILAI BHILAI NAGAR

d) RTGS/NEFT Code SBIN0000574

10. Cheque Number of the Photocopy of Cancelled Cheque Attached (Optional) 632441

I, UPENDRA KUMAR SAHU certify that the statement made by me in this form is correct. I declare that as I receive th

Scholarship, I shall devote my full time to the course of study. I shall maintain good discipline and not indulge in ragginactivities and that I shall not receive any other stipend/scholarship from any other source. If inadvertently payment will breleased by the Board, I will refund without any delay.

VERIFICATION OF THE FORM BY THE HEAD OF THE INSTITUTE/COLLEGE (JOINING REPORT)

This is to certify that UPENDRA KUMAR SAHU S/o, D/o, W/o enrolled in NIT RAIPUR for the course B.TECH has passed in athe subjects in the Semester/Annual examinations held in ___________ (Month& year) of the Course and has scored not lethan 60% marks. He/She has maintained not less than 75% attendance, good discipline and has not involved in ragginactivities.

Place ______________Date: ______________