STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003
CONSTABLES (GD) IN CENTRAL ARMED POLICE
FORCES(CAPFs), NIA, SSF AND RIFLEMAN (GD) IN
ASSAM RIFLES EXAMINATION, 2021
REGISTRATION NO: 20002955657
APPLICATION IS PROVISIONALLY ACCEPTED
1. NAME AS PER MATRICULATION 2. NEW/CHANGED
3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
GAYATRI KUMARI - SAHEB YADAV MALTI DEVI
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/08/2021
10/11/2000 20.8 FEMALE OBC
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA A MOLE MARK ON LEFT SIDE OF FACE
12. MATRICULATION (10th 13. MATRICULATION (10th
11. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
BIHAR SCHOOL EXAMINATION BOARD 1810035 2018
14.1. WHETHER YOU ARE AN EX-SERVICEMAN (ESM) OR
14.2. DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
SERVING IN THE ARMED FORCES?
NO -
14.3. DATE OF DISCHARGE FROM ARMED FORCES
14.4. LENGTH OF SERVICE IN ARMED FORCES
(DD/MM/YYYY)
- -
14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
AVAILING BENEFIT OF RESERVATION FOR EX- 14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
SERVICEMAN (ESM) ?
- -
15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
NO -
16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
16.2. TYPE OF THE NCC CERTIFICATE
CERTIFICATE HOLDER
NO -
17. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)
PATNA ( 3206 ) MUZAFFARPUR ( 3205 ) GORAKHPUR ( 3007 )
18. STATE/ UT OF DOMICILE 19. DISTRICT OF DOMICILE
BIHAR GOPALGANJ
20.1. HAVE YOU MIGRATED FROM THE STATE/ UT 20.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
OF YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
NO -
20.3. STATE/ UT OF ORIGIN 20.4. DISTRICT OF ORIGIN
- -
21. CANDIDATE BELONGS TO MILITANCY/ NAXAL
22. CANDIDATE BELONGS TO BORDER DISTRICT
AFFECTED DISTRICT
NO NO
23. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
B,A,D,E,F,H
24. HIGHEST EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
25. DETAILS OF QUALIFYING EDUCATION
10TH STANDARD
STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
YEAR UNIVERSITY UNIVERSITY
PASSED 2018 BIHAR BIHAR SCHOOL 1810035 47.6 -
EXAMINATION
BOARD
26. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN TERMS
OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
NO
ADDRESS DETAIL
27. CORRESPONDENCE ADDRESS 28. PERMANENT ADDRESS
H/O RAJU YADAV VILL -RAMPUR MAKUND PO -SISWA PS- H/O RAJU YADAV VILL -RAMPUR MAKUND PO -SISWA PS-
BISHWMBHR PUR BISHWMBHR PUR
DISTRICT: GOPALGANJ DISTRICT: GOPALGANJ
STATE: BIHAR STATE: BIHAR
PIN: 841503 PIN: 841503
MOBILE NO. : 9142073985 EMAIL ID: ryrajiv2@[Link]
29. DATE ON WHICH PHOTOGRAPH HAS BEEN TAKEN 30. WHETHER THE DATE OF PHOTOGRAPH IS CLEARLY
(DD/MM/YYYY): PRINTED ON THE PHOTOGRAPH
26/07/2021 YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED - - -
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE
NOTICE OF THE EXAMINATION.
2. I HEREBY DECLARE THAT ALL 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 OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE CANCELLED.I AM
WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 28/07/2021 [Link] PM IP ADDRESS: [Link]