SUlpRAG sine Lestlunsn’ Bssfeunencem Tamil Nadu Public Service Commission Name ofthe Post Applying for / eSlatbramrciuSabgsih Lpsefluer Liu, Notification Number / sgflfldbenes err Application Number / flores ser Registration Date UBay 256) Name ofthe Applicant «flares cigs fle Luis Gender / umeSteria Date of tinh / Ips CBB Fathers Name/ sibenpuing QU Mothers Name/ mum Gus, Marital Status / Bapioem planes Applicants birth District / ledresruisira’ Spies woreut. ib Applicants Native District «flarem Cause wirefes wrreuc Lib Father's Bith District sibensswir erbgs iorrauc Lc Fathers Native District / pibemsuumrs pels omauc Lib Nationality @—s@ us @erb Religion / wi Communal Category /auesciuy Name ofthe Sub - Caster) 2. 1SfleSleée Quis Certificate No ensiralsib reir Date of ssue /eneir Dp uprisUcL as Issulng Authority enero aupi@us Bers District / wreuLid Taluka COMBINED CIVIL SERVICES EXAMINATION - (GROUP -1 ERVICES] 1672022 216181613 wsnorron S VENKATESAN MAE 13406-1998, [ASIANESAN SAMUTHA UnwaReaeD CUDDALORE CUDDALORE CUDDALORE CUDDALORE CITIZEN OF INGIA HINDU SCHEDULED CASTE 50) vaLWvaN 522613 10-102008, TAHSILDAR CHENNAI EGMORE ‘Special Category and their Certificate Details muy ut LAN floysci torhaud seu Meir erates sleurmEset ‘Are youa Diferentl Aled Person? Bric won fdgssEAmernatusn? Have you claimed exemption from Tail Egity est? Nreyoua Gonempoyes? Bue sipeiuenfusnargn? Employment Status / ese lene ‘Are you an BeServiceman / Grier apeeret Mes BenDT? sou en trad aed ye ae omen ihe ate omnes econ Spiatncnuih nielp eure) ope Srinud ans Psooiernd esiaacr wgpid OB flaysald sobs! Carded afroidebs siiseren BirbsroTECeuT 260g! 60 SAIC STOSBHE AOSD mausesr Sane BeSBccctm dette ower” NO/@evene Nos @éene Nos meee UNEMPLOFED NO /eaevenes NO /@eveneHas any criminal case ever been registered aganst you til date? / @unset S1eoT BriBE SBI OHMEAUIO KDHE GBD USucue Odrensm? Do you have more than one ining wife?/ Brive SermIsG GunUcL AULA MOSEL geen (oer) AsneiT Gree? Do you possess prescribed Physical Standard as per notification? / rues BYarUsSUUCL 216 BEB OUdpsetjsarn? Do you possess prescribed Standard of Vision Standard It / Standard I or Better as per notification? / Briescr BigeroruNoULL wireneu ‘@iner Standard IL Standard lor Better Qubmuchafaserr? NO/@svenes NOs @evenes YES / suid YES / aud Communication Details / O51 HL MSs oleurivesci ‘des for Communication / Qs. si unsscurfl ‘Address Line 1 / qpeseutf 1:35 BEACH ROAD ‘Address Line 2 / qpascutf|2: VANNIVARFALAVAM, Town/Talukity /psib/eu vab/uorpbaspih: CUDDALORE District / wore: CUDCALORE State /uorflevih : TAMIL NADU Pincode / siedee was era : 607001 Permanent Address nibs wnescur ‘Address Line 1 / qoeseurl 1:35 BEACH ROAD ‘Address Line 2 / qpescurfl 2: VANNIVARPALAVAW, ‘Town/lalulCty/ppasgth/euch/iom pas : CUDDALORE District woreut tb: Cuddalore State / vores: TAMIL NADL Pincode/ suede wnluS@ erie: 60700 Emall 1D / leirardyrc) wpascu: venkatdchn98@gmailcom Mobile Number / enasCiGi@ err : 7657665873 Educational Qualification Particulars / Adal 560 EMSs Sanmecir SSC /udrerf Qu) aust Date of Publication of Result /¢p Gey wney Qe GUC. 5B 23-05-2014 Name ofthe Board / @mrousesepioib STATE BOARD Certificate Number ene ei 3950434 Have you studied Tami as one of the Subject/Language ?/wiSlenp ow YES / ayib Unions OSE! SBIEE Aub guctotsn ? HSC OR EQUNALENT QUALIFICATION / Gindorfleneut icheles ca sicvergi Genomruron BAAS 5G Date of Publication of Result / Gay (nigel QevetIL.OLICL ee 17.05.2016 Name ofthe Course ig cuSer Lui HSCISENIOR SECONDARY CERTFICATEINTERMEDIATE/PRE UNIVERSITY Name ofthe Board /@mpeusesepio STATE BOARD Cerificate Number ence sie 11317479 Have you studied ai a one of the Subject/Language?/ sen 9w * YES/ oui UnLions Ossi G5}8 Gubprcrat on? SELECT THE STATUS OF EDUCATIONAL QUALIFICATION POSSESSED BY YOU ON THE CATE OF NOTIFICATION(21.07.2022) / ugftflésenss pyar gy (21.07.2022 BHETB SHAS BEBE Brouwer GAAIGS: HAVE PASSED AND QUALIFIED IN DEGREE OR EQUNALENT QUALIFICATION INCLUDING INTERNSHIP FOR THOSE CANDIDATES WHO POSSESS MBBS OR (CTHER MEDICAL QUALIFCATION) / jeans Lice wevel) acres Aoarusren SOAS SEBUM CHFEAL Quibaucraarcir MBBS BOOB! ID HBSGIA CEIaISCd GOD LATS eHjcd Bp FeO Quay a craflepLIy (Internship) LUA OUD wusercramar VESiagioDate of Publication of Result G5 (piggy Gee CUCL 25B) "Name ofthe Degree with Major Subject / ucts Luge Quai Name ofthe Major Subject/ apgpesreints Lime Bes OL Name ofthe Board / Univesity / @pFaysecpinia/Licreemevsapeia Certificate Number | smeirafiip rai Mode of study Have you studied ‘Tami as one ofthe Subjecs/Language ?/ BiSlenyp Gu UnLins «Ossi C588) QUbpieraton? 10-2020 BACHELOR OF SCIENCE 50 cHEMIsTRY “THIRUVALLUVAR UNIVERSITY 2aosiasr2 REGULAR YES /aub Preferential Qualifications Do you posses any National Award) for Physical eficen NO/@éenes Physical Requirements Height in cms 160 Chest Measurement (nfl aspiration in ems 108 (nfl expation in ems 10: Difference (Expansion in cms 3 PSTM DETAILS ‘Do you want to claim reservation against Persons Studied the prescribed NO uations) in ail Medium(PST¥P / ipeomuBbasILL wees Soeiloer gAp uddyGonBusE wiseDsbsrer PSTMIAL GBs ACErT Sesion? svaminati ‘Name of the Examination centre-1 / @gijey anows @leir Quwg-1 Chidambaram (0303) Name ofthe Examination centre2/ @piay soins Beir QLiw-2 Chennai (0101 Main Writen Examination /ungseienings Garou Name ofthe Examination centre/@asfay enows@er Qiu hennai(o101) Subject for Examination Preliminary amination Langséo lanevs sey Subject for Examination / @psGeAipesmear urLib ‘i I sndard\Code, 003), Aptitude ane Hisar Ses Sls eareeSandraycode 009, Antitude an Man Writen Fxamination /angseirenings Gases Subject for Examination / @pGeBlesrar wrt APSF Ely et (SLC Standard) (Descriptive ype} PAPER PAeSGerieral Studies (Degree Standard) (Descriptive type) Abeer Studs (Degree Standard) (Descriptive type) AbeRerlStudes (Degree Standard) (Descriptive type)PAYMENT MODE:No Fee (Payment Exempted) Declaration / 2 oy) Guorys 2h ne through the Instructions tothe Applicants an the Commission's notification for this Recruitment before filing up the application form and undertake to abide by the same. Ap janmarus@er aneniugnsiaendarer silaenracr” obo OuugDkars Bendus UGC. Geka APAsoavinarwd u9ss 9s IAC DAA us OGY LIS AeligicrGeer, seus ester Buibsenenseoses BLUBMENYr cox Ber ened a HBueMsGeper. 2. The Information furnished by mein this application and the details avallabe inthe PREVIEW page are found correct. Siig BairearCug Ge e.crar Raupach gob wercernl. SHed acter Slaigracr slenens gb wfluire e.chenen, da ental aay das are core and tam aare that cane th detail the st data aso ding the corecton window period free Ge acter Alauriisd Wray efluns acter cord encrpe send, AeineniusPeoer sofLIISEU Verars AareTUsBA sielbeicier Haurwanct POSS CeLap Sars seNbsuuc Geer sre SvsrepApecr Copeedu Hlaphisman Doss Aeiu Qugud cerieng wre ai6\Gacr, 4, am lso are that my aplaon candidature sb for eectn at any tage ofthe selec proces, any fhe deta fund be wrongin this application. B15 AairemLLBH a cror Haigriac SapTE HuBbENe, As VBler erie Mencvidiguia camgs eleremrciLss BloMEASS LGD cere Bren wees sinleover. 5. Thereby declare that al the particulars furnished inthis application are tre, corect and complete tothe best of my knowede and bel Inthe event of any ‘place ble ound leo crt or nity beg deed before afer te eanaon ot ay tag an acon an be take gant meby the MAAK IUsHS GHA Asin Heuprsoerendeosuid Uiad—1 UNI spoH, sano cer sige eciguisvens RerenouTErene, efunaronsy opp (PYsDUTETENSL. CEIADS woerCun Hog IDIST HOB TE EGeTs—r PDadaugdsahed se5guh suprerena, aaraandsss ypburenna Hog SEGuwereno sor SHyuLes Bod eflabrowr cs Monafiy ecu canis Spjarmemuh cHsgb adellp pagsnsse a OuuGeacr, 6 Ince ante apa ary Kadena Sa re Nehetisane aac an prac Soeeom bedmons aL. Stoials owpuBsed commute siombed poBameub aubgecaa co. pB aaSepe, 8, declare that posses the Physical standards prescribed forthe post) which am now applying for. . 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Pg OSTLGUTS ohs sods. SOgud obs clssSauid a flew Gary Sect Se Eendlgtas Sbchai seh Myebbabins aani nde aed Sonat oprcon s6oig! BTOZOTS QUbOToAT sEjAMMaTUsOSs GMD mMOTL OLA ceraid 2. DS moOMeMer Cogd Msi AsT-GuTs Senne es ete Sethian ee tAPSla in anttn trust Boast 5. Male