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    ApplicationFormDraftPrintForAll

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    ritwikghosh346

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    © All Rights Reserved
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    ApplicationFormDraftPrintForAll

    Uploaded by

    ritwikghosh346
    2 views3 pages

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    © © All Rights Reserved

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    © All Rights Reserved
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    2 views3 pages

    ApplicationFormDraftPrintForAll

    Uploaded by

    ritwikghosh346

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    © All Rights Reserved
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    STAFF SELECTION COMMISSION

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


    110003
    CONSTABLES (GD) IN CENTRAL ARMED POLICE FORCES
    (CAPFs), SSF AND RIFLEMAN (GD) IN ASSAM RIFLES
    EXAMINATION 2024

    REGISTRATION NO: 40006872495

    APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

    1. NAME AS PER MATRICULATION 2. NEW/CHANGED


    3. FATHER'S NAME 4. MOTHER'S NAME
    CERTIFICATE NAME
    SARIFUL SHAIKH - MANIK SHAIKH MUSTAKIMA BIBI
    5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2024 7. GENDER 8. CATEGORY
    28/12/1999 24 MALE OBC
    9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
    CITIZEN OF INDIA MOLE ON THE FACE
    12. MATRICULATION (10th 13. MATRICULATION (10th
    11. MATRICULATION (10th CLASS) EXAMINATION BOARD
    CLASS) ROLL NO CLASS) YEAR OF PASSING
    WEST BENGAL BOARD OF SECONDARY EDUCATION 0159 2016
    14.1. WHETHER YOU ARE AN EX-SERVICEMEN (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 THE ARMED FORCES
    (DD/MM/YYYY)
    - -
    14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
    AVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMEN 14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
    (ESM) ?
    - -
    15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
    YES 02-OBC
    16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
    16.2. TYPE OF THE NCC CERTIFICATE
    CERTIFICATE HOLDER
    NO -
    17. PREFERENCE OF EXAMINATION CENTRES

    EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER


    ( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)

    KOLKATA ( 4410 ) BURDWAN ( 4404 ) KALYANI ( 4419 )

    18. MEDIUM FOR COMPUTER BASED 19. STATE/ UT OF DOMICILE 20. DISTRICT OF DOMICILE
    EXAMINATION (CBE)
    BENGALI WEST BENGAL MURSHIDABAD
    21.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 21.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
    YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
    NO -
    21.3. STATE/ UT OF ORIGIN 21.4. DISTRICT OF ORIGIN
    - -
    22. CANDIDATE BELONGS TO MILITANCY/ NAXAL
    23. CANDIDATE BELONGS TO BORDER DISTRICT
    AFFECTED DISTRICT
    NO YES
    24. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
    H,D,F,B,C,E,A,
    25. HIGHEST EDUCATIONAL QUALIFICATION
    MATRICULATION/ 10TH CLASS PASS(1)
    26. DETAILS OF QUALIFYING EDUCATION
    10TH STANDARD
    STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
    YEAR UNIVERSITY UNIVERSITY
    PASSED 2016 WEST BENGAL WEST BENGAL BOARD 0159 51.86 -
    OF SECONDARY
    EDUCATION
    27. 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
    28. CORRESPONDENCE ADDRESS 29. PERMANENT ADDRESS
    VILL SALU PO SALU VILL SALU PO SALU
    DISTRICT: MURSHIDABAD DISTRICT: MURSHIDABAD
    STATE: WEST BENGAL STATE: WEST BENGAL
    PIN: 742401 PIN: 742401
    MOBILE NO. : 7076955277 EMAIL ID: sari1916ful@gmail.com
    30. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 24-AUGUST-2023?
    YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

    NOT EXEMPTED 100 CPADIGQZJ7 10/12/2023


    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.

    4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.


    PRINT TAKEN ON: 22/10/2024 10:29:44 AM IP ADDRESS: 103.215.225.19

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