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APSC Eligibility Application Form

This document contains an application form submitted by Dipshikha Das to the Assam Public Service Commission. The form provides her personal details such as name, father's name, date of birth, category, address, education details including degrees obtained from Gauhati University. She declares that she has not been debarred from any examinations and is applying for the Combined Competitive Preliminary Examination-2013. She also declares that all information provided in the application is true and correct.

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19 views2 pages

APSC Eligibility Application Form

This document contains an application form submitted by Dipshikha Das to the Assam Public Service Commission. The form provides her personal details such as name, father's name, date of birth, category, address, education details including degrees obtained from Gauhati University. She declares that she has not been debarred from any examinations and is applying for the Combined Competitive Preliminary Examination-2013. She also declares that all information provided in the application is true and correct.

Uploaded by

bidyuttezu
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ASSAM PUBLIC SERVICE COMMISSION

*******
Application form
DIPSHIKHA DAS
RAKHAL DAS
BUSINESS
SANGITA DAS
Female
INDIAN
16/11/1991
NO
SC
LALUK (SBI GOHAINPUKHURI)
VILL- LALUK
CARE OF BIDYUT DUTTA
LALUK
784160
LALUK
BIHPURIA
Assam
Lakhimpur
LALUK (SBI GOHAINPUKHURI)
VILL- LALUK
CARE OF BIDYUT DUTTA
LALUK
784160
LALUK
BIHPURIA
Assam
Lakhimpur
Degree
Commerce
07/07/2013
GAUHATI UNIVERSITY
Age as on 01/01/2013:
21
Name of Candidate
Father's Name
Father's Occupation
Mother's Name
Gender
Nationality
Date of Birth
Category
University
Disability Percentage
Locality
House No./Street Name etc
Present City/Town/Village
Present Post Office
Present Pin Code
Present Police Station
Present Sub Division
Present State
Present District(for Assam only)
Present District(for other states)
Locality
House No./Street Name etc
Permanent City/Town/Village
Permanent Post Office
Permanent Pin Code
Permanent Police Station
Permanent Sub Division
Permanent State
Permanent District(for Assam only)
Permanent District(for other states)
Degree
Stream
Year Of Passing
Are you a Person with disability
Disability Type
Registration No
06111719141
Optional Subject
Examination Centre
Commerce
North Lakhimpur
Have you ever been debarred from applying for any Government post
Other Information Details
NO
Post/Exam. Applied for
Have you ever been debarred from any Examination and/or selection conducted by the
UPSC or any State PSC:
NO
Years
Age Condonation
NO
COMBINED COMPETITIVE PRELIMINARY EXAMINATION-2013
Page No:1
Degree Division
Percentage
of Marks
Year of
Passing
Board/University
Duration of
Degree
HSLC I 69.50
27/05/2008
1 SEBA
HS I 68.40
21/05/2010
2 AHSEC
Degree II 49.73
07/07/2013
3 GAUHATI UNIVERSITY
Declaration:
Place:
18/09/2013 1.51 PM
Date:
Signature of Applicant
I hereby declare that all statements made in this application are true, complete and correct to the best of my
knowledge and belief. In the event of any information being found false or ineligibility being detected before or after
the examination, action may be taken against me as the Commission may deem fit.
I have read the terms and conditions of the Commission as published in the advertisement carefully and do hereby
undertake to abide by them or any other terms and conditions as may be applicable to me.
I further declare that I fulfill all the eligibility conditions prescribed for admission to the examination.
I declare that I have not been debarred by the APSC or UPSC or any other State PSCs.
I also declare that I am not a dismissed Govt. employee.
I have informed my employer in writing that I am applying for this Examination.(Applicable for employed person only).
I hereby declare that I will not be a party to any kind of canvassing on my behalf.
NOTE:Please don't send this Application Form to APSC.
Page No: 2

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