Mitu Form

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07/02/2019 https://www.sssc.gov.in/Print.

aspx

Post Applied for: CLERK


Public Notice No.: 25C/SSSC/HR/2019
Advertisement Date: 05/01/2019
State Apply For: Haryana

Registration ID: 66259167


Name SUMIT KUMAR
Father's Name: PURAN CHAND
Husband's Name
Date of Birth: 21/01/1994
Gender Male
Category: BC-B of Haryana
In case Ex-Serviceman of Haryana , Details of service rendered in military:
Joining Date:
Relieving Date:
Marital Status: Unmarried
Have you passed matriculation with Hindi as one of the subject: Yes
Whether the candidate belogns to certain categories of women i.e. Widow,
No
Divorced, Legally Separated, Wives of Serving Military Personnel:
Whether the applicant is Government Employee: No
If Regular Employee, name of organization:
Do you have proficiency in operation of computer: Yes
Have you ever been convicted for any criminal offence involving moral
No
turpitude?
If Yes, then give details:
Have you ever been named as accused in any criminal case? No
If Yes, then give details and decision/pendency of the case:
Whether you are ever dismissed or removed from service of any state Govt.
No
Or Govt. of India or any public sector undertaking:
If Yes, then give details:

State: Haryana
District: Karnal
VILL MOHRI JAGIR,PO SITAMAI,TEH
Address for correspondence: NILOKHERI,DIST KARNAL,STATE
HARYANA,PIN 132001
VILL MOHRI JAGIR,PO SITAMAI,TEH
Permanent Address: NILOKHERI,DIST KARNAL,STATE
HARYANA,PIN 132001
Mobile No. 8813088830
Email Address: [email protected]

Payee Bank: State Bank of India


Branch Code: 001600
Branch Name: SBI KURUKSHETRA UNIVERSITY
Branch City: KURUKSHETRA
Transaction/Journal No.: 48511104
Date of Payment: 06/02/2019
Application Fee: 200

Sr. No. Exam Passed Stream University/Board Year of Passing Total Marks Marks Obtained % of Marks/CGPA
1 Matric Matric HBSE 2009 500 203 40.60
2 Graduation B.A KUK UNIVERSITY 2015 2382 1276 53.57
3 Post Graduation
4 Other Qualification 1
5 Other Qualification 2
6 Other Qualification 3
I undertake to work anywhere in the State where I may be posted, If selected.
I hereby declare that the information given is true and correct to the best of my knowledge & belief and bind me personaly. If found to be false, I
shall be liable for criminal prosecution apart from other consequences.

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