Haryana Staff Selection Commission

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ONE TIME REGISTRATION FOR CET-'C'-01/2025 PREVIEW PAGE

Basic Details

Photo Signature

Full name as per matriculation VIKAS

Father's name RAGHBIR

Mother's name NANHI

Date of birth as per 10-08-2001

matriculation

Gender MALE

Marital status UNMARRIED

Mobile number 9896109759

Email address [email protected]

Aadhaar number 444599206738

Identification marks 1 MOLE ON FACE

Identification marks 2

Have you participated in the NO

CET 01/2022

Address Information

Correspondence address Permanent address

Address VOO FARMANA Address VOO FA

BADSHAHPUR MEHAM
MEHAM ROHTAK

Village/City/Sector FARMANA Village/City/Sector FARMA

BADSHAHPUR

Post office MEHAM Post office MEHAM

State HARYANA State HARYA

District ROHTAK District ROHTA

Pin code 124112 Pin code 124112

Category Information

Are you a Domicile/ Bonafide YES

resident of Haryana?

Domicile certificate number HR/2020/2576

Domicile certificate issue Date 11-11-2020

Domicile certificate issuing NAIB TEHSILDAR MEHAM

authority name

Category DSC

Category certificate number HRDSCJ/2025/118850

Category certificate issue date 01-06-2025

Category certificate issuing ADC CUM DCRIO ROHTAK

authority name

Have you worked or presently NO

working on
adhoc/contract/workcharged/
daily wages basis in any
Department/ Board
,Corporation of Haryana
Government including
Government-aided lnstitutions
under Haryana Government ?

Are you an Ex- NO

Serviceman/Family Member
of Ex-Serviceman?

Are you a Dependent of NO

freedom fighter (DFF)?

Are you a PWD (Person with NO

Benchmark Disability)
Candidate?

Are you an Eligible sports NO

person (ESP) ?

Do you have any criminal No

case against you?

Educational Qualification
 Examination Duration Course Board/university Stream Year o
Passed Type Name passin

10TH - - BOARD OF 10TH 2020

SCHOOL WITH
EDUCATION HINDI
HARYANA

12TH - - BOARD OF ARTS 2022

COMPLETED SCHOOL
EDUCATION
HARYANA

Declaration

Uploaded Documents

Photo Click here to view photo

Signature Click here to view signature

Aadhar Click here to view Aadhar

Undertaking as per Annexure Click here to view Undertaking as per annexu

-VII

Domicile Certificate Click here to view domicile certificate

Category Certificate Click here to view category certificate

10th Click here to view 10th certificate

12th completed Certificate Click here to view 12th completed certificates

Important: Please carefully review the information provided above. If

any details are incorrect, kindly make the necessary corrections now.
Once the form is submitted, no further changes will be allowed.

CLICK HERE TO EDIT OTR FORM

Have you filled the form by yourself ? * Yes No

I hereby declare that all the information and particulars

filled in this application are true, complete, and correct to
the best of my knowledge and belief. I understand that
any misrepresentation, omission or concealment of facts
may lead to the cancellation of my candidature at any
stage of the recruitment process or termination of my
employment, if appointed.

SUBMIT OTR FORM

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