Government of India

Staff Selection Commission

Print Form
STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003

Multi-Tasking (Non-Technical) Staff, and Havaldar (CBIC & CBN)

Examination, 2024
REGISTRATION NO: 10013087639

Application Completed(Contents Not Verified)

1. CANDIDATE'S NAME (AS PER THE

2. NEW/ CHANGED NAME 3. GENDER 4. CATEGORY
MATRICULATION CERTIFICATE)
NAWAZ AHMED - Male UR

7. DATE OF BIRTH (DD/MM/YYYY)

5. FATHER'S NAME 6. MOTHER'S NAME
(AS PER THE MATRICULATION CERTIFICATE)

SHARIF DIN ZARIFA BAGUM 01/03/2002

8. AGE AS ON 01/08/2024 9. NATIONALITY 10. VISIBLE IDENTIFICATION MARK

22 Years 5 Months 1 Day Citizen of India A BLACK MOLE ON LEFT EYEBROW

11. WHETHER A PERSON WITH BENCHMARK DISABILITY (PwBD) ? 11.1. IF YES, TYPE OF DISABILITY (OH, HH, VH, OTHERS)

No -

13. MATRICULATION (10th CLASS) YEAR OF

12. MATRICULATION (10th CLASS) EXAMINATION BOARD 14. MATRICULATION (10th CLASS) ROLL NO.
PASSING

Jammu and Kashmir State Board of School Education 2020 5913225

ADDRESS DETAILS
15.1 CORRESPONDENCE ADDRESS 16.1 PERMANENT ADDRESS

DEWAL NIOCH REASI DEWAL NIOCH REASI

15.2. STATE: Jammu and Kashmir 16.2. STATE: Jammu and Kashmir

15.3. DISTRICT: Reasi 16.3. DISTRICT: Reasi

15.4. PIN: 182315 16.4. PIN: 182315

17. EMAIL ahmedmnnawaz@gmail.com 18. MOBILE NUMBER 9682325363

19. HIGHEST EDUCATIONAL QUALIFICATION

Matriculation(10th)

20. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION

20.1. EQ STATUS 20.2. PASSING YEAR 20.3. STATE/ UT of BOARD

Passed 2020 Jammu and Kashmir

20.4. NAME OF BOARD

JAMMU AND KASHMIR STATE BOARD OF SCHOOL EDUCATION

20.5. ROLL NUMBER 20.6. PERCENTAGE 20.7. CGPA

5913225 43.2

21. WHETHER YOU ARE AN EX-SERVICEMAN (ESM) OR SERVING IN THE ARMED FORCES? 21.1 DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
No -

21.2. DATE OF DISCHARGE FROM ARMED FORCES (DD/MM/YYYY)? 21.3. LENGTH OF SERVICE IN ARMED FORCES
- -
21.4. HAVE YOU ALREADY JOINED A CIVIL POST BY AVAILING BENEFIT OF RESERVATION FOR EX-
21.5. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
SERVICEMAN (ESM) ?

No -

22. WHETHER SEEKING AGE RELAXATION ? 22.1. IF YES, AGE RELAXATION CODE
No

23. DO YOU WANT TO MAKE YOUR PERSONAL INFORMATION AVAILABLE FOR ACCESSING JOB OPPORTUNITIES IN TERMS OF DOP&T'S OM NO.39020/1/2016-ESTT.(P) DATED 21/06/2016?
Yes

24. PREFERENCE OF EXAMINATION CENTER

24.1. EXAMINATION CENTER (FIRST PREFERENCE ) 24.2. EXAMINATION CENTER (SECOND PREFERENCE ) 24.3. EXAMINATION CENTER (THIRD PREFERENCE )
NWR-Jammu (1004) NWR-Samba (1010) NWR-Srinagar (J&K) (1007)

25. MEDIUM FOR COMPUTER BASED EXAMINATION (CBE):

English (02)

26.1. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?
No

26.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BOTH ARMS AFFECTED (BA) OR CEREBRAL PALCY (CP)?

No
 26.3. DO YOU HAVE PHYSICAL LIMITATION TO WRITE AS PER PARA 7.2 OR 7.3 OF THE NOTICE?
(CERTIFICATE TO THIS EFFECT FROM COMPETENT ATHORITY AS PER FORMAT AT ANNEXURE-1/ANNEXURE-1A TO THE NOTICE OF EXAMINATION, WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
No

26.4. WHETHER SCRIBE IS REQUIRED?

No

26.5. WILL YOU MAKE YOUR ARRANGEMENT OF SCRIBE?

No

26.6. IF SCRIBE IS TO BE ARRANGED BY SSC, THEN INDICATE MEDIUM?

-
27. Preference of State(s)/ UT(s)/ CCA(s):

11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 2406690b8d58f7047f 08/07/2024
 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.

3. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.

PRINT TAKEN ON: 08-07-2024 8:54 AM

NUMBER OF ATTEMPT(s): 1

(Signature)

IP ADDRESS: 117.98.100.40

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