STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
HEAD CONSTABLE (MINISTERIAL) IN DELHI POLICE
EXAMINATION, 2022

REGISTRATION NO: 40004459058

APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFICATE NAME
NIDHI - SURENDER SEEMA
5. DATE OF BIRTH
6. AGE AS ON 01/01/2022 7. GENDER 8. CATEGORY
(DD/MM/YYYY)
10/12/2003 18 FEMALE UNRESERVED
9. WHETHER PERSON WITH DISABILITY (PwD)? 9.1 IF YES, TYPE OF DISABILITY
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA NO
14. MATRICULATION
13. MATRICULATION
12. MATRICULATION (10th CLASS) EXAMINATION BOARD (10th CLASS) YEAR OF
(10th CLASS) ROLL NO
PASSING
BOARD OF SCHOOL EDUCATION HARYANA 2019293425 2019
15. DO YOU POSSESS OBC CATEGORY CERTIFICATE NOTIFIED IN THE CENTRAL LIST OR BY THE GOVT. OF NCT OF
DELHI ?
NO
16. WHETHER A WIDOW/ DIVORCED/ JUDICIALLY SEPARATED WOMEN?
NO
17. WHETHER DEPARTMENTAL CANDIDATE OF DELHI POLICE ?
NO
18. WHETHER SON/ DAUGHTER OF SERVING, RETIRED OR DECEASED PERSONNEL/ MULTI-TASKING STAFF OF DELHI
POLICE
NO
19. HAVE YOU REPRESENTED A STATE AT THE NATIONAL LEVEL OR THE 19.1. IF YES, DISCIPLINE OF YOUR
COUNTRY AT THE INTERNATIONAL LEVEL IN SPORTS DURING PRECEEDING SPORT
3 YEARS FROM THE CLOSING DATE OF RECEIPT OF ONLINE APPLICATIONS?
NO -
20. MEDIUM OF COMPUTER BASED EXAMINATION (CBE)
ENGLISH
21. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
DELHI ( 2201 ) DEHRADUN ( 2002 ) HARIDWAR ( 2005 )
 22.1. WHETHER YOU ARE AN EX- 22.2. DATE OF JOINING THE ARMED [Link] OF DISCHARGE/ LIKELY
SERVICEMAN (ESM) OR SERVING FORCES (DD/MM/YYYY) DATE OF DISCHARGE FROM ARMED
IN THE ARMED FORCES? FORCES (DD/MM/ YYYY)

NO - -

22.5. HAVE YOU ALREADY JOINED A

22.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT OF 22.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES RESERVATION FOR EX-SERVICEMAN (DD/MM/YYYY)
(ESM) ?

- - -

23.1. WHETHER SEEKING AGE 23.2. IF YES,INDICATE CODE

RELAXATION ?
NO -
24.1. ARE YOU A NATIONAL CADET CORPS (NCC)
24.2. TYPE OF THE NCC CERTIFICATE
CERTIFICATE HOLDER ?
NO -
25. MEDIUM FOR TYPING TEST:
ENGLISH
26.1. DO YOU POSSESS DEGREE/ POST GRADUATE
26.2. IF YES, CLASS OBTAINED IN DEGREE/ POST
DIPLOMA AWARDED BY RASHTRIYA RAKSHA
GRADUATE DIPLOMA:
UNIVERSITY (RRU)?
NO -
27. HIGHEST EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
28. DETAILS OF QUALIFYING EDUCATION
12TH STANDARD
STATE/ UT OF
NAME OF BOARD/ PERCENT
STATUS PASSING YEAR BOARD/ ROLL NO CGPA
UNIVERSITY AGE
UNIVERSITY
HARYANA BOARD
OF EDUCATION,
PASSED 2021 HARYANA 3021338984 84.20 -
HANSI ROAD,
BHIWANI.
29. 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 DETAILS
30. POSTAL ADDRESS 31. PERMANENT ADDRESS
PATEL NAGAR GALI NO 23 WARD NO 10 NARWANA PATEL NAGAR GALI NO 23 WARD NO 10 NARWANA

DISTRICT: JIND DISTRICT:JIND

STATE: HARYANA STATE: HARYANA
PIN : 126116 PIN : 126116
MOBILE NO: 9466630791 EMAIL: nidhikoshik143@[Link]
32. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 17-FEB-2022?

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.

3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.
PRINT TAKEN ON: 16/06/2022 6:06:31 PM IP ADDRESS: [Link]