Application Registration No : 60000552787 for Combined Graduate Level Examination-2016

1.& 2. Examination Center and Code :

NWR-Bathinda(1401)

3. Candidate Name :

SHUBHAM

4. Father's Name :

MOHINDER PARTAP

5. Mother's Name :

SAVITA KUMARI

6. Date of Birth(dd/mm/yyyy):

22/07/1994

7. Gender :

Male

8. Nationality :

Indian

9. Fee Exemption claimed :

Fee Paid

10. Category :

General

10.1. Whether Ex-Serviceman? :

No

10.2. If, ExS, Whether seeking reservation? :

10.3. For Ex-Serviceman-Length of Service(in years) :
10.3. Date of discharge :
11. Whether PH :

No

11.1. If yes, indicate code :

12. Whether seeking Age relaxation :

No

12.1. If yes, indicate code :

12.2. Age(as on 01.01.2016) :

21.5

13. Preference for posts :

HEGDCNBKLMJIPSOA#%@ZYTUVWXQRF$

14. Are you applying for the posts of Statistical Investigator Gr.II/ Compiler ? : No
14. Do you possess EQ for the posts of Statistical Investigator Grade II/
Compiler? :

No

14. Are you applying for the posts of AAO ? :

No

14. Do you possess EQ for the posts of AAO ? :

No

15. Whether you belong to Religious Minority Communities as per Govt.

Orders ? :

No

16. If VH/ Cerebal Palsy candidate, whether scribe is required ? :

No

16.1. If yes, indicate medium :

17. Aadhar Card Number :

506988483856

18. Qualification Details (Start from Graduation) :

Educational Qualification

Subject

B.Sc.

Chemistry

Percentage(%)of Marks

Medium
English

19. Details of Work Experience/Govt. Service rendered :

Name of the Organisation(s)

Designation

Nature of Duty(ies)

Period Of Service
From(mm/yyyy)

Period Of Service
To(mm/yyyy)

Nil

Nil

Nil

Nil

Nil

Contact Details Form :

20. Postal Address :

HNO. 425 PIND DA ANDRALA HISSA NEAR GURUDWARA NIRMAL

GARH SAHIB V.P.O KAONI MUKTSAR DISTRICT PUNJAB PIN 152031

State :

Punjab

Pincode :

152031

21. Permanent Address :

HNO. 425 PIND DA ANDRALA HISSA NEAR GURUDWARA NIRMAL

GARH SAHIB V.P.O KAONI

State :

Punjab

Pincode :

152031

STD Code :

01633

Phone Number :

270022

Mobile Number :

8054831144

Email ID :

shubhamkaoni227@gmail.com

Payment Details Form :

Transaction id :

CP45656956

Transaction Date(yyyy-mm-dd) :

2016-03-20

Payment Mode :

online

Amount :

100

PHOTOGRAPH AND SIGNATURE :

SCANNED PHOTOGRAPH OF THE CANDIDATE:

SCANNED SIGNATURE OF THE CANDIDATE

DECLARATION:
I hereby declare that all the 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 false or incorrect at any stage or not satisfying the eligibility criteria according to the requirements of the relative
advertisement, my candidature/appointment is liable to be cancelled/terminated. I am willing to serve anywhere in India.
Place:
Date(yyyy-mm-dd) : 2016-03-20
Signature of Candidate