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Priya Application Form CHSL

1) The document is an application for the Combined Higher Secondary Level Examination submitted by Priya Bharti. 2) It provides her personal details like name, father's name, date of birth, gender, nationality, category, educational qualifications and contact information. 3) The application status is shown as provisionally submitted and it lists the examination centers she has selected.

Uploaded by

Sachin Kumar Choudhary
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154 views

Priya Application Form CHSL

1) The document is an application for the Combined Higher Secondary Level Examination submitted by Priya Bharti. 2) It provides her personal details like name, father's name, date of birth, gender, nationality, category, educational qualifications and contact information. 3) The application status is shown as provisionally submitted and it lists the examination centers she has selected.

Uploaded by

Sachin Kumar Choudhary
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
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Staff Selection Commission

Block No. 12, CGO-Complex, Lodhi Road, New Delhi 110003


COMBINED HIGHER SECONDARY LEVEL (10+2)
EXAMINATION-2017
Registration No: 64011360194

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code


CR-Muzaffarpur(3205) 3205
CR-Patna(3206) 3206
CR-Varanasi(3013) 3013
Candidate's Full Name Father's Name Mother's Name
PRIYA BHARTI NIRANJAN MAHASETH NIRMALA DEVI
Date of Birth Gender
1996-01-24 Female
Nationality Fee Category
Indian Exemption claimed OBC
If Ex-serviceman Length of Service Date of Discharge If, ExS, Whether eligilble for
reservation?
No
Whether PH? If yes,indicate code If Cerebral Palsy? Do you suffer from If VH/Cerebral Palsy/ If yes, indicate
Locomotor Disability Locomotor whether medium
(40% or more) scribe is required?
wherein the dominant
writing extremity is
affected to the extent
of slowing down the
performance?
No
Indicate Age relaxation code Age as on 01.08.2018 Indicate medium for Typing Test Do you possess educational
qualification of 12th standard pass
in Science stream with
Mathematics as a subject from a
recognised Board or equivalent
(for DEO in C&AG)?
22.6 English Yes
Mark of visible identification Whether belong to Minority Communities?
CUT OF MARK ON RIGHT EYEBROW No
Mode of Fee Payment Amount Transaction-ID Transaction Date

Educational Qualification (Please note that possession of Intermediate/Higher Secondary/12th Standard Qualification is
a pre-requisite to apply for this examination,However you may indicate your highest qualification)
B.Sc.(Hons.)

Do you want to make available your personal information publicly 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
Communication Address Permanent Address
D/O NIRANJAN MAHASETH MOH-PANDASARAI PO AND PS- DO NIRANJAN MAHASETH MOH PANDASARAI PO
LAHERIASARAI LAHERIASARAI PS LAHERIASARAI DIST DARBHANGA PIN
846001
City: LAHERIASARAI State: Bihar
District: DARBHANGA Pin Code: 846001
State: Bihar Mobile No.: 7631029986
Pin Code: 846001 Email Id: priya.cmsc@gmail.com

Declaration
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

Printed on:(mm/dd/yyyy)12/04/2017 12:31:05

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