GOVERNMENT OF GUJARAT Submit Date :
Application No:
Umbrella Scheme for Education of ST Students Post-Matric 242500000001082321
Scholarship(Freeship Card / Medical Loan Student Only)
Fresh Application
Student Basic Details
Name of Student : NINAMA ANKITBHAI PRAVINBHAI
Name of Student (As per Aadhar) : NINAMA ANKITBHAI PRAVINBHAI
Mother's Name : HUMLIBEN
Date of Birth : 24/07/2001 Gender : Male
Category : ST(7ȵkɅlISKWĤiS Religion :Hindu
Caste : Bhil [j_
Aadhaar Status Verified: Yes(06/11/2024 14:46:56)
Ration Card No. : 318002006554941 Ration Card Member No. : 318002006554941004
Name As Per Ration Card: (Ninama Ankitbhai Pravinbhai / iWWh\hӔDS[h9̆iaR[h:
EKYC Status As Per Ration Card: Yes EKYC Date: 05-11-2024
Aadhar Number Matched With Ration Card: Yes
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): 95000 Habitation Type: Rural
Mobile Number : 6354641430 E-mail Address :
[email protected]Aadhar No : 46xxxxxx6784 Parent/Guardian occupation: Agriculture(EpSj
Is Orphan: NO Day Scholar / Hosteller : Hosteler
Marital Status : Unmarried Hostel Type: Grant In AID Hostel
Current Address: Permanant Address:
State Gujarat State Gujarat
District Patan District Dahod
Taluka Patan Taluka Jhalod
Village Dharpur Village Karath
PinCode 384265 PinCode 389180
Address:BOYS HOSTEL,GMERS MEDICAL Address:KAMBOI FALIYU, AT- KARATH
COLLEGE,DHARPUR-PATAN
Student Bank Account Detail/Aadhar Bank Detail
I voluntarily give my consent to use my Aadhaar details.
Aadhar Number : 46xxxxxx6784 Bank name : -
NPCI Date : 11/6/2024 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 : 21xxxxxx7267 IFSC Code : BKID0002112
Student Name(As per Bank Name): ANKIT PRAVINBHAI NINAMA
Name of Bank : BANK OF INDIA
Branch Name & Address : INFOCITY
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: Medical
Present Course/Class/Trade Name : MBBS Bachelor of Medicine and Bachelor of Surgery
Present Course/Class/Trade Year : 4TH YEAR(7th Semester/8th Semester)
Studying in : Gujarat Enrollment No: MBBS4041867938
Present Institute District : Patan Present Institute : G M E R S MEDICAL COLLEGE DHARPUR
Admission Type : Regular Paid Seat (Self Finance) Present Branch Course : -
Enter Your Research/Thesis Subject :
Present Class Start Date : 01-Mar-2023 Present Course Completion Date : 01-Mar-2024
Fees Amount
Admission Fees (Rs) 0
Tution Fees (Rs) 300000
Misc.Fee(NonRefundable Fees) 32400
Exam Fees(Rs) 3010
Total (Rs) 335410
Previous stream :MBBS Bachelor of Medicine and Bachelor of Surgery Previous Class/Course : 3RD YEAR(5th Semester/6th Semester)
Previous Passing Year : 2024 Previous (%) : 55.33
Educational Break : No No. Of. Year in Break :
Are You Employed in any Organization/Establishment with leave without pay? : No
Freeship Card Detail
Freeship Card No: 178/2018
Freeship Card Issued Date: 06/07/2018
Freeship Card Issued by District:Patan
Freeship Card Issued By Designation ID : Asst. Tribal Officer
Name of course for which Free ship card is issued : MBBS
Indicate the details of Exemption Fees (Total Fees Amount Not Taken by
Institute/college/University) :
Admission Fee(In Rs.) : 0
Tution Fee(In Rs.) : 300000
Misc.Fee(In Rs.)(Non Refundable) : 32400
Exam Fee(In Rs.) : 3010
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Previous Education Detail
Course/Class/Trade Type Course/Class/Trade Name Branch Name Seat No Passing Year Percentage
9th Std/10th Std 10TH SSC A4262113 2016 68.16
11th Std/12 Std 12TH HSC B131016 2018 58.16
Medical MBBS Bachelor of Medicine and Bachelor of FIRST YEAR 00611 2020 53
Surgery
Medical MBBS Bachelor of Medicine and Bachelor of SECOND YEAR 589 2022 57
Surgery
Medical MBBS Bachelor of Medicine and Bachelor of THIRD YEAR 00043 2024 55.33
Surgery PART 1
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 Self Attested Certificate of Previous academic marksheet
4 Income Certificate From the Concerned Authorised Authority/Persons
5 Hostel Certificate(Only For Hosteller Student)
6 Std:12 Marksheet(If Any)
7 Freeship Card
8 Identity Card (College/School)
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 : 06/11/2024
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
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Date :
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