Government of India
Staff Selection Commission
Print Form
STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003
Combined Graduate Level Examination
REGISTRATION NO: 10015071560
Application Completed(Contents Not Verified)
1. CANDIDATE'S NAME (AS PER THE
2. NEW/ CHANGED NAME 3. GENDER 4. CATEGORY
MATRICULATION CERTIFICATE)
YASHVARDHAN PAL - Male OBC
7. DATE OF BIRTH (DD/MM/YYYY)
5. FATHER'S NAME 6. MOTHER'S NAME
(AS PER THE MATRICULATION CERTIFICATE)
ANIL PAL GEETA PAL 29/01/2003
8. AGE AS ON 01/08/2025 9. NATIONALITY 10. VISIBLE IDENTIFICATION MARK
22 Years 6 Months 4 Days Citizen of India CUT MARK ON FOREHEAD
11. WHETHER A PERSON WITH BENCHMARK DISABILITY (PwBD) ? 11.1. IFYES, TYPE OF DISABILITY (OH, HH, VH, OTHERS)
No -
12. MATRICULATION (10th CLASS) EXAMINATION BOARD 13. MATRICULATION (10th CLASS) YEAR OF PASSING 14. MATRICULATION (10th CLASS) ROLL NO.
Madhya Pradesh Board of Secondary Education 2018 181430504
ADDRESS DETAILS
15.1 CORRESPONDENCE ADDRESS 16.1 PERMANENTADDRESS
D-35 NEW GOVINDPURI CITY CANTER KULPATI NIVAS K PICHE D-35 NEW GOVINDPURI CITY CANTER KULPATI NIVAS K PICHE
15.2. STATE: Madhya Pradesh 16.2. STATE: Madhya Pradesh
15.3. DISTRICT: Gwalior 16.3. DISTRICT: Gwalior
15.4. PIN: 474002 16.4. PIN: 474002
17. EMAIL ypal91268@gmail.com 18. MOBILE NUMBER 9301983272
19. HIGHEST EDUCATIONAL QUALIFICATION
Graduation
20. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
Graduation
20.1. EQ STATUS 20.2. PASSING YEAR 20.3. STATE/ UT of BOARD/ UNIVERSITY
Passed 2023 Madhya Pradesh
20.4. NAME OF BOARD/ UNIVERSITY
JIWAJI UNIVERSITY, GWALIOR(M.P.)
20.5. ROLL NUMBER 20.6. PERCENTAGE 20.7. CGPA
201479798 67.2
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 BYAVAILING 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. IFYES, 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?
No
24. PREFERENCE OF EXAMINATION CENTER
24.1. EXAMINATION CENTER (FIRST PREFERENCE ) 24.2. EXAMINATION CENTER (SECOND PREFERENCE ) 24.3. EXAMINATION CENTER (THIRD PREFERENCE )
MPR-Gwalior (6005) MPR-Indore (6006) CR-Agra (3001)
25.1. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?
No
25.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BOTH ARMS AFFECTED (BA) OR CEREBRAL PALSY (CP)?
No
25.3. DO YOU HAVE PHYSICAL LIMITATION TO WRITE AS PER PARA 7.2 OR 7.3 OF THE NOTICE?
(CERTIFICATE TO THIS EFFECT FROM COMPETENTATHORITYAS PER FORMATATANNEXURE-1/ANNEXURE-1ATO THE NOTICE OF EXAMINATION, WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
No
25.4. WHETHER SCRIBE IS REQUIRED?
No
25.5. WILLYOU MAKE YOUR ARRANGEMENT OF SCRIBE?
No
25.6. IF SCRIBE IS TO BE ARRANGED BY SSC, THEN INDICATE MEDIUM?
26.1 ARE YOU ALSO APPLYING FOR THE POST OF JUNIOR STATISTICAL OFFICER (MOSPI)?
No
26.2 DO YOU POSSESS EQ FOR THE POST OF JUNIOR STATISTICAL OFFICER (MOSPI): STATISTICAL OFFICER (MOSPI)?
No
27.1 ARE YOU ALSO APPLYING FOR THE POST OF STATISTICAL INVESTIGATOR GRADE II (RGI): STATISTICAL OFFICER (MOSPI)?
No
27.2 DO YOU POSSESS EQ FOR THE POST OF STATISTICAL INVESTIGATOR GRADE II (RGI)?
No
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 2515cb5432c67124e1 17/06/2025
DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPTALL THE TERMS & CONDITIONS MENTIONED THEREIN.
2. I HEREBY DECLARE THATALL 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 MYAADHAAR DATA FOR VERIFICATION PURPOSE.
PRINT TAKEN ON: 17-06-2025 6:55 PM
NUMBER OF ATTEMPT(s): 1
(Signature)
IP ADDRESS:
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