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    Staff Selection Commission: Combined Higher Secondary (10+2) Level Examination, 2020

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    sagarsengar27

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Staff Selection Commission: Combined Higher Secondary (10+2) Level Examination, 2020

    Uploaded by

    sagarsengar27
    2 views3 pages

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    Ssc

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    2 views3 pages

    Staff Selection Commission: Combined Higher Secondary (10+2) Level Examination, 2020

    Uploaded by

    sagarsengar27

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    STAFF SELECTION COMMISSION

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


    110003

    COMBINED HIGHER SECONDARY (10+2) LEVEL


    EXAMINATION, 2020

    REGISTRATION NO: 30002432612

    APPLICATION IS PROVISIONALLY ACCEPTED


    1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
    MATRICULATION CERTIFICATE NAME
    RASHMI GUPTA - NARENDRA MOHAN GUPTA KUSUM GUPTA
    6. AGE AS ON
    5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
    01/01/2021
    07/07/1998 22.5 FEMALE UNRESERVED
    9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)

    NO -

    10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION


    CITIZEN OF INDIA AADHAR CARD
    12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
    BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
    BOARD OF HIGH SCHOOL AND INTERMEDIATE
    0416046 2012
    EDUCATION UTTAR PRADESH
    15. PREFERENCE OF EXAMINATION CENTERS
    EXAMINATION CENTRE EXAMINATION CENTRE EXAMINATION CENTRE
    (FIRST PREFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE)
    AGRA ( 3001 ) KANPUR ( 3009 ) LUCKNOW ( 3010 )
    17. WHETHER 12TH STANDARD PASS IN SCIENCE STREAM WITH
    16. MEDIUM FOR TYPING TEST: MATHEMATICS AS A SUBJECT FROM A RECOGNIZED BOARD OR
    EQUIVALENT(FOR C&AG AS DATA ENTRY OPERATOR):
    ENGLISH YES
    18.WHETHER EX- 18.1. DATE OF DISCHARGE 18.2. LENGTH OF SERVICE IN THE ARMED FORCES (IN
    SERVICEMAN (ESM) ? FROM ARMED FORCES YEARS)
    (DD/MM/YYYY)

    NO - -
    18.3. HAVE YOU ALREADY JOINED A CIVIL POST BY 18.4. DATE OF JOINING THE CIVIL POST (DD/MM/YYYY)
    AVAILING BENEFIT OF RESERVATION FOR EX-
    SERVICEMAN (ESM) ?
    - -
    19.1. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
    -
    19.2. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
    (CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
    SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
    WOULD BE REQUIRED AT THE TIME OF EXAMINATION) ?
    -
    19.3. WHETHER SCRIBE IS REQUIRED ? 19.4. WILL YOU 19.5. IF SCRIBE IS TO BE ARRANGED BY SSC, INDICATE
    MAKE YOUR MEDIUM
    OWN
    ARRANGEMENT
    OF SCRIBE ?
    - - -

    20. WHETHER SEEKING AGE RELAXATION ? 20.1 IF YES, AGE RELAXATION CODE

    NO
    -
    21. HIGHEST QUALIFICATION
    INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
    22. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
    EQUIVALENT TO 12TH STANDARD
    STATE/ UT OF NAME OF BOARD/
    STATUS PASSING YEAR ROLL NO PERCENTAGE CGPA
    BOARD/ UNIVERSITY UNIVERSITY
    BOARD OF HIGH
    SCHOOL AND
    PASSED 2014 UTTAR PRADESH INTERMEDIATE 0319909 87 -
    EDUCATION
    UTTAR PRADESH
    23. 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 ?
    NO
    ADDRESS DETAIL
    24. CORRESPONDENCE ADDRESS 25. PERMANENT ADDRESS
    VILL - LAUHARRA POST - SASNI VILL - LAUHARRA POST - SASNI

    DISTRICT: HATHRAS (MAHAMAYA NAGAR) DISTRICT:HATHRAS (MAHAMAYA NAGAR)


    STATE: UTTAR PRADESH STATE: UTTAR PRADESH
    PIN : 204216 PIN : 204216
    MOBILE NO: 8218502254 EMAIL: [email protected]
    27. DATE ON WHICH PHOTOGRAPH HAS BEEN TAKEN 28. WHETHER THE DATE OF PHOTOGRAPH IS CLEARLY
    (DD/MM/YYYY): PRINTED ON THE PHOTOGRAPH
    16/12/2020 YES
    FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
    EXEMPTED - - -
    DECLARATION
    1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS
    MENTIONED THEREIN.

    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.
    PRINT TAKEN ON: 22/12/2020 7:18:13 AM IP ADDRESS: 139.167.233.89

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