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Government of Karnataka
Department of Backward Classes Welfare
Student Application cum Verification Report for Incentives : 2018-19

Student Details

Application Number : 2018H0059793

Student Name : VISHWANATHA S

Gender : Male Date of Birth : 09-07-1998

Category : Cat-IIIA Caste : Vakkaliga(Sl.No-1-(b))

Mobile Number : 7026452094 Email ID : -NA-

Aadhar Number : XXXX XXXX 2311

Address : 125, BCWD Hostel Siddapura

Qualification Details

Course : Degree Registration Number : 1CR16CS180 Course Details : BE (COMPUTER SCIENCE)

Course Type : Semester Marks Secured in : Grade Point(CGPA)

Total Maximum Marks : 20 Total Obtained Marks : 15.6 Percentage : 78.00

Bank Details

Bank Name : KOTAK MAHINDRA BANK LTD (ING VYSYA BANK)

Bank Branch Name and IFSC Code : VYSA0001310--PATHAPALYA

Account Number : 131010129242

Declaration by Hostel Supdt/Warden

District: .Taluka: Hostel:

I declare that Mr/Ms VISHWANATHA S was the student of during __________ Academic year.He belongs to
Cat-IIIA.He has passed _________________ Course with ____________ Class.

Date :

Place : Signature and Name of the Hostel Supdt/Warden

Note : The hard copy duly signed by Hostel Supdt/Warden is to be submited to the BCEO along with relevent documents.

Verification by BCEO

I have verified the contents with reference to the original certificates,physically

identified with the following certificates.
All Marks Cards : Yes No Bank Pass Book : Yes No

Date :
Signature and Name of
Place : the BCEO
Verification by DOBC

I have verified the contents with reference to the original certificates,physically

identified with the following certificates.

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Date :
Signature and Name of
Place : the DOBC

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