01/07/2016

ViewExaminationFormI

PrintApplicationForm

UTTARPRADESHSECONDARYEDUCATIONSERVICESSELECTIONBOARD
IDeclarethatIhaveReadthedetailedUserManul&Notification.

NotificationDetails(Examination)

Advertisement/NotificationNumber:

01/2016EXAM/General

ApplyFor:

2016/
Candidate'sPersonalDetails

CandidateRegistrationNo.:

UP0020091461001007003
UP00210010516025

CandidateName:

VIJAYKUMARNIGAM

Father's/Husband'sName:

BANGALIBABUNIGAM

Mother'sName:

KUSUMJAYANT

GenderDateofBirth:

Male27/09/1984

AreyouDomicileofUP?/Catgory:

Yes/SC

AreyouMarried?

No

ContactNo./EmailID:

9897341035/runvijay3@gmail.com

ApplicationID:

BankTransactionDetails

BankNamePaymentMode:

StateBankOfIndiaINB

Fees,TransactionIDDate:

Rs.375.00,IG0CGOPJL501/07/2016
OtherDetailsofCandidate

AreyouDependentofUPFreedomFighter?

No

ServiceDuration(DayMonthYear):

0
0
0

AreyouUPEx.Army?

No

RetirementDate(Date/Month/Year):

//

AreyouECO/SSCO/COofArmy?

Haveyoucomplete5yearservice?

Haveyourservicesbeenextendedfor
rehabilitationandnodisciplinaryactionis
pendingagainstyou?

HaveyoueverbeenDebarredfromany
SelectionBoard/Commission?:

CompletionDateofDebarment
(DD/MM/YYYY):

AreYouHandicapofUP?

No

AreyouDeaforHavehearingproblem?:

No

AreyouBlindOrHaveVisionproblem?:

No

HaveyouanyphysicalProblem?:

No

AreYouSkilledPlayerOfUP?:
LevelofPlayer:

No

N/A

HighSchool&IntermediateBoard,Yearofpassing&RollNumberDetails
Sr.No Examination
Passed
1.
HighSchool
2.

BoardName

UTTARPRADESHBOARDOFHIGHSCHOOLAND
INTERMEDIATEEDUCATION
Intermediate UTTARPRADESHBOARDOFHIGHSCHOOLAND
INTERMEDIATEEDUCATION

https://pariksha.up.nic.in/Online_App/View_ExamApplicationForm1.aspx?ID=UP00210010516025

Yearof
Passing

Roll
Obtained
Number Marks

Total
Marks

2002

0017633 351

600

2005

0000689 266

500

1/3

01/07/2016

ViewExaminationFormI

ChoiceofExamination
CenterDistrict:

1:AGRA
2:LUCKNOW
3:KANPURNAGAR

EssentialQualificationDetails
Year
Roll
Passed/Appeared Board/Inst/Univ Of
Number
Passing

Qualification

Yes

DRBRA
UNIVERSITY
AGRA

2008

8146060235 No

660.00 1350.0048.89

Yes

DRBRA
UNIVERSITY
AGRA

2011

11222141274 No

430.00 800.00 53.75

No

NA

NA

No

NA

NA

No

NA

NA

000000

Is
Obtain Total Percentage
Grade
Marks Marks (%)
System

00

000/00

Candidate's
Correspondence/Mailing
Address

AddressDetails

Candidate'sPermanent
Address

Name(C/O):

BANGALIBABUNIGAM BANGALIBABUNIGAM

Houseno./Village:

MIG304SECTOR15B
AVASVIKASCOLONY

MIG304SECTOR15BAVAS
VIKASCOLONY

StreetNo./PostOffice:

SIKANDRA

SIKANDRA

State/DistrictName:

UTTARPRADESH/
AGRA

UTTARPRADESH/
AGRA

Tahsil:

AGRA

AGRA

PoliceStation:

SIKANDRA

SIKANDRA

Block:

BICHPURI

BICHPURI

Village:

AGRA(MCORP.)

AGRA(MCORP.)

PIN:

282007

282007

PhotoSignature
Details
Photo&Signature

1.IherebydeclarethatIhavereadalltheprovisionsinthenotice/advertisementoftheexaminationcarefullyand
herebyundertaketoabidebythem
2.IfurtherdeclarethatIfulfillalltheconditionsofeligibilityregardingagelimits,educationalqualificationsetc.
prescribedforadmissiontotheexamination.
https://pariksha.up.nic.in/Online_App/View_ExamApplicationForm1.aspx?ID=UP00210010516025

2/3

01/07/2016

ViewExaminationFormI

3.IdecalrethatmyclaimforreservationasSC/ST/OBCcandidate'saretrueandcorrectandIaminpossessionofmy
castecertificateintheprescribedformatgiveninthenotice/advertisementoftheexamination.Ialsodeclarethatasper
Govt.orderNo.22/16/92/T.C.IIIDATED22102008Idonotbelongtotheperson/sections(creamylayer)mentionedin
it.
4.I(formalecandidates)alsodeclarethatIhavenomorethanonewifeliving/(forfemalecandidates)havenotmarried
amanalreadyhavingawifeliving.
5.IalsodeclarethatIhaveneverbeenconvictedbyanycourtoflaw.Ialsodeclarethatnocriminalcaseispending
againstme.FurtherdeclarethatIhaveneverbeendismissedorremovedfromGovt.Serviceormyservicebeen
terminatedduringprobation.
6.Iherebydeclarethatalltheentries/statementsmadeinthisapplicationaretrue,completeandcorrecttothebestof
myknowledgeandbelief.Intheeventofanyinformationbeingfoundfalseorincorrectorineligibilitybeingdetected
beforeorafterselectiontheBoardcantakeactionagainstmeasperrulesincaseitisdetectedthatIhavemisleadthe
BoardonanyissuethenIwillsolelyresponsibleforallpenalconsequencesthereof.

Iaccepttheabovedeclaration: Yes
Currentstatusofapplication
Yourapplicationisunderprocessing.
ApplicationFormSubmissionDate:01/07/2016,Time:6:42:35PM
ApplicationFormprintingDate&Time:[01/07/2016,6:42:58PM]

https://pariksha.up.nic.in/Online_App/View_ExamApplicationForm1.aspx?ID=UP00210010516025

3/3