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Visible Identification Marks in SSC Form

1) The document is an application registration for the Combined Higher Secondary Level Examination in 2016. It provides details of the applicant such as name, father's name, date of birth, gender, nationality, category, address and contact details. 2) It specifies the examination center as SR-Kurnool with code 8003. The applicant's name is given as ADAVI VENKATAHEMANTH and his preferred post is PDELC. 3) It also includes payment details, a signature and a declaration signed by the applicant.

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Venkata Hemanth
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123 views2 pages

Visible Identification Marks in SSC Form

1) The document is an application registration for the Combined Higher Secondary Level Examination in 2016. It provides details of the applicant such as name, father's name, date of birth, gender, nationality, category, address and contact details. 2) It specifies the examination center as SR-Kurnool with code 8003. The applicant's name is given as ADAVI VENKATAHEMANTH and his preferred post is PDELC. 3) It also includes payment details, a signature and a declaration signed by the applicant.

Uploaded by

Venkata Hemanth
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

11/9/2016

[Link]/chsl/pdfprint/[Link]

Application Registration No: 63006351570 for the Combined Higher Secondary Level Examination - 2016
Your Application is Completed
SR-Kurnool(8003)
1.& 2. Name of Computer Based written Examination Center and Code :
SR-Kurnool(8003)
SR-Kurnool(8003)
[Link] Name :

ADAVI VENKATAHEMANTH

[Link]'s Name :

ADAVI SUBBARAYUDU

[Link]'s Name :

ADAVI SUJATHA

[Link] of Birth (dd/mm/yyyy) :

23/03/1994

[Link] :

Male

8. Nationality :

Indian

[Link] Exemption claimed :

Fee Paid

[Link] :

OBC

[Link] Ex-Serviceman? :

No

10.2. For Ex-Serviceman-Length of Service(in years) :


10.2. Date of discharge (dd/mm/yyyy) :
10.3. Whether eligible for Ex-Serviceman Reservation? :
No

11. Whether PH (PWD) :


11.1. If yes, indicate code :
11.2. Whether suffering from cerebral palsy? :
11.2. If VH/Cerebal Palsy candidate, whether scribe is required ?
11.3. if yes indicate medium :
12. Whether seeking Age relaxation? :

No

12. If yes, indicate code :


12.1. Age(as on 01.01.2017) :

22.9

13. Preference for posts :

PDELC

14. Indicate medium for Typing Test :

English

14.1. Do you possess knowledge of Typing Test ? :

Yes

15. Aadhar Card Number (If available):

360906917054

[Link] of Visible Identification :

A BLACK MOLE ON THE NECK.

17. Whether you belong to Religious Minority Community ? :

No

18. Educational Qualification :

[Link]

19. Do you want to make available your personal Information for the
accessing job opportunity in terms of DoP & T's [Link]. 39020/1/2016-Estt. Yes
(B) dated 21.06.2016 ? :
22/92 PATHAKADAPA KADAPA
[Link] Address :
Village/City :

PATHAKADAPA

District :

KADAPA

State :

Andhra Pradesh

Pincode :

516002

[Link] Address :

22/92 PATHAKADAPA KADAPA 516002

State :

Andhra Pradesh

Pincode :

516002

STD Code :
Phone Number :
9553305360

Mobile Number :

venkatahemanth.a@[Link]

Email ID :
[Link]

[Link]

[Link]

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11/9/2016

[Link]/chsl/pdfprint/[Link]

Payment Details :

Transaction id :
Transaction Date(yyyy-mm-dd) :
Payment Mode :
Amount :

CP64020391
2016-11-08
online
100

Declaration

I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and
belief. I understand that in the event of any information being found suppressed false or incorrect or ineligibility being detected
before and after examination, my candidature/appointment is liable to be cancelled.
Place:
Date (yyyy-mm-dd):2016-11-09
Signature of Candidate

Print Application Form


Go to SSC Online Application Home Page

[Link]

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