STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003
MULTI TASKING (NON-TECHNICAL) STAFF, AND
HAVALDAR (CBIC & CBN) EXAMINATION, 2021
REGISTRATION NO: 50001808929
APPLICATION IS PROVISIONALLY ACCEPTED
1. NAME AS PER MATRICULATION 2. NEW/CHANGED
3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
MUKUL KUMAR - VED PRAKASH GEETA
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2022
05/04/2001 20.8 MALE SC
9. WHETHER PERSON WITH DISABILITY (PwD)? 9.1 IF YES, TYPE OF DISABILITY
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA MOLE ON FACE
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
CENTRAL BOARD OF SECONDARY EDUCATION (CBSE) 8738695 2017
15. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
( FIRST PREFERENCE ) ( SECOND PREFERENCE ) ( THIRD PREFERENCE )
DELHI ( 2201 ) HARIDWAR ( 2005 ) AJMER ( 2401 )
16.1. WHETHER YOU ARE AN EX- [Link] OF DISCHARGE/ LIKELY
16.2. DATE OF JOINING THE ARMED
SERVICEMAN (ESM) OR SERVING DATE OF DISCHARGE FROM ARMED
FORCES (DD/MM/YYYY)
IN THE ARMED FORCES? FORCES (DD/MM/ YYYY)
NO - -
16.5. HAVE YOU ALREADY JOINED A
16.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT OF 16.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES RESERVATION FOR EX-SERVICEMAN (DD/MM/YYYY)
(ESM) ?
- - -
17.1 WHETHER SUFFERING FROM CEREBRAL PALSY
-
17.2 DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
-
17.3 WHETHER SCRIBE IS REQUIRED 17.4 WILL YOU MAKE YOUR OWN 17.5 IF SCRIBE IS TO BE
ARRANGEMENT OF SCRIBE? ARRANGED BY SSC, INDICATE
MEDIUM
- - -
18.1. WHETHER SEEKING AGE RELAXATION? 18.2. IF YES,INDICATE CODE
YES 01-SC/ST
19. STATE(S) / U.T.(S) / CCA(S) PREFERENCE CODE
19. STATE(S) / U.T.(S) / CCA(S) PREFERENCE CODE
20,18,13,21,35,45,49,11,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,
X,X,X,X,X,X,X,X,X
20. HIGHEST EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
21. DETAILS OF QUALIFYING EDUCATION
10TH STANDARD
STATUS PASSING STATE/ UT OF NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
YEAR BOARD/ UNIVERSITY UNIVERSITY
PASSED 2017 DELHI CENTRAL BOARD OF 8738695 - 6
SECONDARY
EDUCATION (CBSE)
22. 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 ?
YES
ADDRESS DETAIL
23. CORRESPONDENCE ADDRESS 24. PERMANENT ADDRESS
H NO D 109 BUDH VIAHR COLONY DHARAM VIR H NO D 109 BUDH VIAHR COLONY DHARAM VIR
MARKET GALI NO 3 MARKET GALI NO 3
BADARPUR NEW DELHI BADARPUR NEW DELHI
DISTRICT: SOUTH EAST DELHI DISTRICT: SOUTH EAST DELHI
STATE: DELHI STATE: DELHI
PIN: 110044 PIN: 110044
MOBILE NO. : 8285217496 EMAIL ID: karanved07@[Link]
26. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 23-DEC-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.
3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.
PRINT TAKEN ON: 05/04/2022 12:16:07 PM IP ADDRESS: [Link]