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CODENO. Valid VALIDITYSTATUS Invalid
1.
NAMEINBLOCKCAPITALSASINMATRICULATIONCERTIFICATE:
2. FATHERSNAMEASINMATRICULATIONCERTIFICATE:
3. PERMANENTADDRESSWITHPINCODE,TELENO,EMAILIDIFANY: DISTRICT STATE TELE EMAIL 4. PRESENTADDRESSWITHPINCODE.TELENO,IFANY: DISTRICT STATE TELE PIN PIN
5.
HighereducationalparticularsSSR Yearof Passing Authorityconducting Exam StatefromwhichExam Passed SerialNo.ofCertificate Marksobtained/total marks / . Percentage
6.
HighereducationalparticularsMR/NMR Yearof Passing Authorityconducting Exam StatefromwhichExam Passed SerialNo.ofCertificate Marksobtained/total marks / . Percentage
Nationalit 7. y
:________________
8.
10.
No
12.Levelofparticipation:International/National/Statelevel
DECLARATION 1. Ihereby declarethatallthestatementsmadeintheapplicationaretruetothebestofmyknowledgeandbelief andtheapplicationhasbeenfilledupbyme 2. Ihaveneverbeendebarredfrom appearinginanyexaminationnor,haveIeverbeenwithdrawnfromDefenceTrainingEstablishmentsondisciplinary grounds,norhaveIeverbeen prosecute o convicted criminalcourtorinvolvedinanyothercase bythepolice.Ihavenotsubmitted arrested, d r by registered more thanoneapplicationforthisbatch. 3. Iundertakenottomakeanyclaimforcompensationif atanystageofselection,ineligibility resul thereof t . detecte formycandidature is d
andmy candidatureiscancelledasa
......
Parentsignature
Signatureof applicant
VisibleIdentificationMarks(atleasttwo):
SIGNATUREOFAPPLICANT
(a) (b)