STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
COMBINED GRADUATE LEVEL EXAMINATION, 2019
REGISTRATION NO: 92000413866
APPLICATION IS PROVISIONALLY ACCEPTED
1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFICATE NAME
VIKASH KUMAR - BHARAT SAH USHA KUMARI
6. AGE AS ON
5. DATE OF BIRTH (DD/MM/YYYY) 7. GENDER 8. CATEGORY
01/01/2020
02/11/1999 20.1 MALE OBC
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 A MOLE ON THE FOR HEAD
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BIHAR SCHOOL EXAMINATION BOARD 61033-1400287 2014
15. DO YOU BELONG TO ECONOMICALLY WEAKER SECTION (EWS) ?
-
16. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PRFERENCE ) (SECOND PREFERENCE ) (THIRD PREFERENCE )
DRABHANGA ( 3202 ) MUZAFFARPUR ( 3205 ) PATNA ( 3206 )
17.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY 17.3. DATE OF DISCHARGE
17.WHETHER EX- 17.2. LENGTH OF SERVICE IN
AVAILING BENEFIT OF FROM ARMED FORCES
SERVICEMAN (ESM) ? ARMED FORCES ( IN YEARS )
RESERVATION FOR EX- (DD/MM/YYYY)
SERVICEMAN (ESM) ?
NO - - -
18. WHETHER SUFFERING FROM CEREBRAL-PALSY ?
-
18.1. 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) ?
-
18.2. WHETHER SCRIBE IS REQUIRED ? 18.3. WILL YOU MAKE YOUR OWN 18.4. IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
- - -
19. ARE YOU ALSO APPLYING FOR THE POST OF JUNIOR 20. DO YOU POSSESS EQ FOR THE POST OF JUNIOR
STATISTICAL OFFICER (MoSPI)? STATISTICAL OFFICER (MoSPI)?
NO -
21. ARE YOU ALSO APPLYING FOR THE POST OF 22. DO YOU POSSESS EQ FOR THE POST OF STATISTICAL
STATISTICAL INVESTIGATOR GRADE II (RGI) ? INVESTIGATOR GRADE II (RGI) ?
NO -
23. WHETHER SEEKING AGE RELAXATION ? 23.1 IF YES, AGE RELAXATION CODE
NO -
25. DO YOU WANT TO MAKE AVAILABLE YOUR
PERSONAL INFORMATION FOR ACCESSING JOB
24. QUALIFICATION DETAILS OPPORTUNITY IN TERMS OF DoP&T'S O.M
NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
BA (HONS.) (6) NO
ADDRESS DETAIL
26. CORRESPONDENCE ADDRESS 27. PERMANENT ADDRESS
VILL- KOTHIYA NEAR BAZAR SAMITI POST- SHISHO DIH VILL- KOTHIYA NEAR BAZAR SAMITI POST- SHISHO DIH
PS- SADAR DARBHANGA PS- SADAR DARBHANGA
DISTRICT: DARBHANGA DISTRICT:DARBHANGA
STATE: BIHAR STATE: BIHAR
PIN : 846005 PIN : 846005
MOBILE NO: 7563849758 EMAIL: vivanvikash.vk@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 CPW2428494 14/11/2019
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: 14/11/2019 1:06:00 PM
