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APPLICATIO N FO RM FO R Short Se rvice Commission (SSC) Education De c 13 BATCH


(UNMARRIED MALE/ FEMALE CANDIDATES O NLY)
FO R INDIAN NAVY O FFICE USE O NLY
CO DE
VALIDITY STATUS APPLICATIO N NO -SGD1340404153
NO .
Ple ase Attach Photo
He re

Valid Invalid

1. CHOICE OF ENT RY- [1] SSC(EDU)


2. PERSONAL PART ICULARS AS IN MAT RICULAT ION CERT IFICAT E:-
NAME RAMACHANDRAN NAT IONALIT Y: INDIAN
FAT HER'S NAME Muruge san FAT HER'S OCCUPAT ION/DESIGNAT ION:Busine ss
DAT E OF BIRT H 1990/03/23 DOMICILE: Tamilnadu
GENDER M MARIT IAL ST AT US:Unmarrie d

7. ADDRESS: CORRESPONDENCE ADDRESS PERMANENT ADDRESS


N0.6 Anjane yar koil stre e t Swamy Nagar N0.6 Anjane yar koil stre e t Swamy Nagar
ADDRESS
Ullagaram Ullagaram
DIST RICT Kanche e puram Kanche e puram
ST AT E Tamilnadu Tamilnadu
PINCODE 600091 600091
T ELEPHONE 044 - 22424949 044 - 22424949
MOBILE 9940202329 --NA--
EMAIL [email protected] --NA--
8.EDUCAT ION PART ICULARS:
8(a).Qual/Stream/YOP: B.Te ch / Information
Percentage 67.72%
Te chnology / 2011
Maximum Marks Marks O btaine d Maximum Marks Marks O btaine d
1st Semester 0 0 2nd Semester 1000 624
3rd Semester 900 590 4th Semester 900 639
5th Semester 1000 714 6th Semester 800 504
7th Semester 900 616 8th Semester 500 376
9. I HAVE NOT AT T ENDED ANY SSB T ILL T O DAT E WIT H T HE ARMY/NAVY OR T HE AIR FORCE.
10.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.) Fill NA if not applicable:NA

DECLARATION
1.I, hereby declare that I am unmarried male/female, 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 complete printout of this application duly signed to Post Box No. 04, Chanakyapuri, New Delhi - 110 021 along with the
relevant documents as per instruction/ advertisement.
Signature of Applicant:
Place : ...................... Date: .................. May 16, 2013, 12:43 am
.....................................

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