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    Staff Selection Commission: Multi Tasking (Non-Technical) Staff, and Havaldar (Cbic & CBN) Examination, 2021

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    Asmita Moulick
    This document is a registration application for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2021. It provides personal details of the applicant such as name, father's name, date of birth, gender, nationality, address, education details, photograph details, and declaration of acceptance of terms and conditions of the examination notice. The applicant's provisional application number is 40004266337.

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    Staff Selection Commission: Multi Tasking (Non-Technical) Staff, and Havaldar (Cbic & CBN) Examination, 2021

    Uploaded by

    Asmita Moulick
    29 views2 pages
    This document is a registration application for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2021. It provides personal details of the applicant such as name, father's name, date of birth, gender, nationality, address, education details, photograph details, and declaration of acceptance of terms and conditions of the examination notice. The applicant's provisional application number is 40004266337.

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    This document is a registration application for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2021. It provides personal details of the applicant such as name, father's name, date of birth, gender, nationality, address, education details, photograph details, and declaration of acceptance of terms and conditions of the examination notice. The applicant's provisional application number is 40004266337.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views2 pages

    Staff Selection Commission: Multi Tasking (Non-Technical) Staff, and Havaldar (Cbic & CBN) Examination, 2021

    Uploaded by

    Asmita Moulick
    This document is a registration application for the Multi Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN) Examination, 2021. It provides personal details of the applicant such as name, father's name, date of birth, gender, nationality, address, education details, photograph details, and declaration of acceptance of terms and conditions of the examination notice. The applicant's provisional application number is 40004266337.

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    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: 40004266337

    APPLICATION IS PROVISIONALLY ACCEPTED


    1. NAME AS PER MATRICULATION 2. NEW/CHANGED
    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    NABYENDU SAHA - NAREN SAHA GITA SAHA
    6. AGE AS ON
    5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
    01/01/2022
    28/12/2001 20 MALE 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 CUT MARK ON LEFT HAND INDEX FINGER
    12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
    BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
    WEST BENGAL BOARD OF SECONDARY EDUCATION 405991N0113 2018
    15. PREFERENCE OF EXAMINATION CENTERS
    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
    ( FIRST PREFERENCE ) ( SECOND PREFERENCE ) ( THIRD PREFERENCE )
    KOLKATA ( 4410 ) KALYANI ( 4419 ) ASANSOL ( 4417 )
    16.1. WHETHER YOU ARE AN EX- 16.3.DATE 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
    NO -
    19. STATE(S) / U.T.(S) / CCA(S) PREFERENCE CODE
    19. STATE(S) / U.T.(S) / CCA(S) PREFERENCE CODE
    27,29,34,26,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,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 2018 WEST BENGAL WEST BENGAL 405991N0113 62.28 -
    BOARD OF
    SECONDARY
    EDUCATION
    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
    NETAJI SARANI WEST CHANDIGARH POST KORA NETAJI SARANI WEST CHANDIGARH POST KORA
    CHANDIGARH MADHYAMGRAM CHANDIGARH MADHYAMGRAM
    DISTRICT: NORTH 24 PARGANAS DISTRICT: NORTH 24 PARGANAS
    STATE: WEST BENGAL STATE: WEST BENGAL
    PIN: 700130 PIN: 700130
    MOBILE NO. : 7439599132 EMAIL ID: sahanabyendu06@gmail.com
    26. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 23-DEC-2021?

    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
    NOT EXEMPTED 100 CPABNVGDI4 04/04/2022
    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: 04/04/2022 8:52:20 PM IP ADDRESS: 113.21.77.120

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