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APPLICATION IS INCOMPLETE
1. NAME AS PER 2. NEW/CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION NAME
CERTIFICATE
SRIPATHI VENKATA
- SRIPATHI VENKATA SESHU SRIPATHI SEETHA
RANGANADH
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01-01-2020 7. GENDER
04/05/1997 22.7 MALE
10. MARK OF VISIBLE
8. CATEGORY 9. NATIONALITY
IDENTIFICATION
UNRESERVED CITIZEN OF INDIA A MOLE ON LEFT CHEEK
11. MATRICULATION (10th CLASS) EXAMINATION 12. MATRICULATION (10th 13. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION ANDHRA
1212109915 2012
PRADESH
14. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
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.
PRINT TAKEN ON: 12/09/2019 4:36:05 PM