| Personal Details: |
| Applicant Name : | |
| Guardian Name: | |
| Relationship: |
Father Mother Guardian |
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Caste:
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| Gender: |
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| Date of Birth: |
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| Mobile No.: | |
| UDID No.(if available): | |
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Category of Disability:
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| % of Disability: | |
| Address: |
| Are you a citizen of India:
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YES
NO
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| District: |
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| Block: |
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| Municipality/NAC/GP: |
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| Village/ Locality: |
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| Bank Account Details: |
| A/C Holder Name: | |
| Bank Name: |
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| Branch Name: | |
| IFSC Code: |
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| Account Number: | |
| School/College Details: |
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District* :
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Block* :
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Cluster* :
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| School Name* :
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| Class: | |
| Roll No. : | |
| Scholarship Details: |
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Eligible Scholarship Level:
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Eligible Allowances :
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ESCORT ALLOWANCE
TRANSPORT ALLOWANCE
STIPEND TO GIRLS CWSN
READERS ALLOWANCE
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| Documents & Photographs: |
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Upload Passport Photo:
(Not more than 200KB)
(Only jpg/jpeg/gif/png Files) * |
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Upload Signature/Left Thumb Impression:
(Not more than 200KB)
(Only jpg/jpeg/gif/png Files)* |
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Upload Bank Passbook First Page
(Only jpg/jpeg Files and Less than 400KB)
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Upload Disability Certificate
(Only jpg/jpeg Files and Less than 400KB)
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