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03/02/2017 164.100.129.99/mts/pdfprint/verifyprint.

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ApplicationRegistrationNo:60001236614fortheMultiTasking(NonTechnical)StaffInDifferentStates/UTs,2016
YourApplicationisCompleted
1.&1.1.NameofCenterandCenterCode: SRHyderabad(8601)
SRWarangal(8603)
SRNizamabad(8602)
2.CandidateName: GURRAMVIJAY
3.Father'sName: GURRAMLAXMINARAYANA
4.Mother'sName: SAROJANA
5.DateofBirth(dd/mm/yyyy): 05/08/1991
6.Age(ason01.08.2017): 26.0
7.Nationality: Indian
8.Gender: Male
9.Category: OBC
10.WhetherPH(PWD): No
10.Ifyes,indicatecode:
10.1.WhetherExServiceman?: No
10.2.ForExServicemanLengthofService(inyears):
10.2.Dateofdischarge(dd/mm/yyyy):
11.WhetherseekingAgerelaxation?: Yes
11.1.Ifyes,indicatecode: 02OBC
12.Whethersufferingfromcerebralpalsy?:
12.IfVH/CerebalPalsycandidate,whetherscribeisrequired?
13.ifyesindicatemedium:
14.WhetheryoubelongtoReligiousMinorityCommunity?: No
15.AadharCardNumber(Ifavailable):
16.MarkofVisibleIdentification:
17.State/UTCode: 436275XXXXXXXXXXXXXXXXXXXXXXXXXXX
18.EducationalQualification: Graduate
19.DetailsofWorkExperience:
Periodof Periodof
Nameoftheorganisation Designation NatureofDuty(ies) Service Service
From(mm/yyyy) To(mm/yyyy)
20.PostalAddress: QNO437GANDHINAGAR
Village/City: GODAVARIKHANI
District: KARIMNAGAR
State: Telangana
Pincode: 505209
QNO437GANDHINAGARGODAVARIKHANI
21.Permanent/DomicileAddress:
PINCODE505209
State: Telangana
Pincode: 505209
STDCode:
PhoneNumber:
MobileNumber: 9014085496
EmailID: vijaigoud@gmail.com
22.Photo 23.Signature

PaymentDetails:
Transactionid: IK00CBJPG7
TransactionDate(yyyymmdd): 20170203

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03/02/2017 164.100.129.99/mts/pdfprint/verifyprint.jsp
Amount: 100
Declaration
Iherebydeclarethatallthestatementsmadeinthisapplicationaretrue,completeandcorrecttothebestofmyknowledgeand
belief.Iunderstandthatintheeventofanyinformationbeingfoundsuppressedfalseorincorrectorineligibilitybeingdetected
beforeandafterexamination,mycandidature/appointmentisliabletobecancelled.
Place:
Date(yyyymmdd):20170203
SignatureofCandidate

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