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APPLICATION FORM FOR Permanent Commission (PC) Education Jun16 BATCH

Mohan Kumar Jha has applied for the Permanent Commission (PC) Education Jun16 Batch for the Indian Navy. He is unmarried and has completed his B.Tech in Electronics and Communication in 2014, obtaining 77.35% aggregate. In his application form, he provides his personal details like date of birth, address, contact information, educational qualifications and percentage obtained in each semester. He declares that he has never been arrested or involved in any criminal cases. He agrees to face legal action if any information provided is found to be false.

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Mohan Jha
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188 views

APPLICATION FORM FOR Permanent Commission (PC) Education Jun16 BATCH

Mohan Kumar Jha has applied for the Permanent Commission (PC) Education Jun16 Batch for the Indian Navy. He is unmarried and has completed his B.Tech in Electronics and Communication in 2014, obtaining 77.35% aggregate. In his application form, he provides his personal details like date of birth, address, contact information, educational qualifications and percentage obtained in each semester. He declares that he has never been arrested or involved in any criminal cases. He agrees to face legal action if any information provided is found to be false.

Uploaded by

Mohan Jha
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FORM FOR Permanent Commission (PC) Education Jun16 BATCH

(UNMARRIED CANDIDATES ONLY)


FOR INDIAN NAVY OFFICE USE ONLY

Code No:

For Office use only:

Application No:
(Affix Photograph)

VALID / INVALID
PGD1630403116
1. CHOICE OF ENTRY : [2] SSC(LOG)

[1] PC(EDU)

2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:

NAME:

MOHAN KUMAR JHA

DATE OF BIRTH:

1993/01/12

FATHER'S NAME:

UDAY KANT JHA

FATHER'S OCCUPATION:

PRIVATE JOB

DOMICILE:

Bihar

GENDER:

Male

3.NATIONALITY:

INDIAN

6. ADDRESS:

4.MARITIAL STATUS: Unmarried

5.EMAIL: [email protected]

PERMANENT

PRESENT

VILL-MAHNAPO-MAHNA

VILL-MAHNAPO-MAHNA

DISTRICT

BEGUSARAI

BEGUSARAI

STATE

Bihar

Bihar

PINCODE

851210

851210

TELEPHONE --NA--

06243-265570

MOBILE

9973467214

--NA--

7. EDUCATION PARTICULARS:
Qualification

Stream

Year of Passing

Percentage

B.Tech

Electronics and Communication

2014

77.35%

Maximum Marks

Marks Obtained

Maximum Marks

Marks Obtained

1st Semester

1000

715

2nd Semester

1000

782

3rd Semester

1000

762

4th Semester

1000

748

5th Semester

1000

809

6th Semester

1000

771

7th Semester

1000

786

8th Semester

1000

815

8. I HAVE NOT ATTENDED ANY SSB INTERVIEW TILL DATE

9. Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and obtain NOC from the present employer.) : NA

DECLARATION
1.I, hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never been
arrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police.
2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief.
3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.
4. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiated against me for fraudulent entry and falsification of GOI
documents. I also accept that no TA/DA will be admissible to me in such cases.
5. I have completed my B.Tech as on date.

NOTE:
Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ORDINARY POST
ONLY. You will be intimated via Email or SMS regarding your SSB Call-up, if shortlisted. Kindly check your Email inbox regularly.
Place ______________

Date _____________

October 31, 2015, 8:39 am


Signature of Applicant

2015-10-31 08:33:06

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