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Directorate, Student's Welfare THE MAHARAJA SAYAJIRAO UNIVERSITY OF BARODA APPLICATION FORM FOR FINANCIAL ASSISTANCE/SCHOLARSHIP/FREESHIP/ FEEWAIVER FOR THE 2021-22 To, The Registrar, The Maharaja Sayajirao University of Baroda, Vadodara 390002.

Form No: 00000027734

Sir, I wish to submit application form for Financial Assistance/Scholarship/Freeship/Feewaiver given below are my details.

1.

Name of the Student : BORADHARA YASHPALSINH RANJITSINH

2.

Place of Birth

: JAMBUSAR

3.

Gender

: Male

4.

Permanent Address :

B 3 SHRIJ KUNJ SOCIETY STATION ROAD JAMBUSAR 392150

5.

Correspondence Address:B 3 SHRIJ KUNJ SOCIETY STATION ROAD JAMBUSAR 392150

6.

Contact No. : 8866689985

7.

Name of the Programme of Study : LL.B.

8.

Name of the Institute / Faculty : Faculty of Law

9.

Fee Details of the Applicant :

Others Nos. : 7016866723, 9727120052

CURRENT YEAR COURSE FEE (RUPEES) : Hostel Fee (Rupees)

:

10. University PRN Number: 2020033800076694 11. Aadhar Card Number: 692167141929 12. 13. 14. Admission Category : 14A.Wheather ever Penalised or trial for any offence under any court of Law : No 15. 16. 17.

18. Savings Bank Account Details of the Applicant i. Bank Account No. (Savings ) : ii. IFSC Code : iii. Name and Address of bank: : 19. Family Income Limit : 20. Latest Electricity Bill (Monthly) : 21. Educational Qualification (including marks of semester examination last appeared) Qualification

Board/University Year of Passing

Name & Address of School/College Attempt

Divison

Mark Type %age/CPI

22. Details of the Family members (NO COLUMN IS TO BE LEFT BLANK) Member

Name

Age If working, Name, Add. & Phone nos. of Employer office/ Business

If retired, Annual amount of income last pension being drawn

Income from other Sources

Father Mother/ Guardian 23. Details of Brother's/Sister's of the applicant. Name

Qualificat- AgeWhether If working, Name, Add. Annual If Studying, Annual income Name & Add.Fees of ion Married & Phone nos. of of School/ School/ Employer office College College

24. Details of Family Properties : i. Total plot Area of House (Sq. ft.): 800 ii. If any floor given on rent? : No iii. Is there any shop in the house?: No iv. Is there any shop in the house, given on rent ? : No v. If you have any ancestral agricultural land? : Yes Give the details: 2 acres between father and 3 u vi. Is there any commercial property?: No 25. If you are living in a joint Family, give their total annual income : 0 26. If rented accommodation, address of rented accommodation and what amount of rent is being paid by you? : NA 27. Any other Source of Scholarship / Financial Assistance received / applied for : No 28. Details of Home Appliances : T.V. Motor Cycle Fridge

UNDERTAKING I hereby declare that the above mentioned information furnished by me is true and correct to the best of my knowledge and belief. If any information provided in the application form is found incorrect at any stage or it is found that I had failed in any one or more of the Subject of the university examinations or otherwise was ineligible to be considered for financial assistance under this scheme on the last date of submission of application, may be rejected and amount, if any, received by me from the university shall be refunded along with penalty, as decided by the university. This is without prejudice to other disciplinary and other legal measures which the University may take besides the refund of the financial assistance received. I hereby declare that no other scholarship has been availed by me. I upload herewith my certified copies of the supporting documents as required.

1. Result with 55% overall passing marks 2. Fee Slip 3. Faculty Identity Card 4. Salary Slip of self or your parents or latest Income Certificate issued by the competent authority of Govt. of Gujarat 5. Latest Electricity Bill of your family or residence 6. Copy of front page of your own BANK OF BARODA ( Branch within Vadodara City but preferably University Campus Branch ) bank account passbook. 7. Disabled Identification card certified by civil surgeon (if applicable) 8. BPL Card (if applicable) 9. Rent agreement or latest rent payment receipt ( if residing on rent ) 10. For Defence Certificate from competent authority(District sainik welfare & resettlement officer or commanding officer.) 11. Death Certificate of Parents

Applicant Signature...