APPLICATION FOR 8 SSC (MEN) / 37 SSC (WOMEN) F(P) COURSE: JUL2011

(Strike out whichever is not applicable)

FOR OFFICE USE ONLY FOR AFSB USE

APPLICATION NO. Board

1. NAME IN BLOCK CAPITALS AS IN MATRICULATION CERTIFICATE: Affix self

attested passport
size colour
photograph
2. FATHER’S NAME AS IN MATRICULATION CERTIFICATE: (DO NOT
STAPLE)
3. PERMANENT ADDRESS WITH PIN CODE AND TELE NO, IF ANY:

PI TELE
N
4. PRESENT ADDRESS WITH PIN CODE AND TELE NO, IF ANY: (FOR CORRESPODENCE)

PI TELE
N

5. Date of Birth (DD/MM/YY):

(AS PER MATRICULATION CERTIFICATE)
6. Marital Status: Single/Married/Widower/Widow/Divorce ……………………..………...…………………….
7. Nearest railway Station(Present Address): …………………………..….……………………….…………….
8. Nationality: …………………………………………………………………………………………………….
9. Gender: (Male/Female) ………………………………………………………………………………………...
10. E-mail: ……………………………………………………………………………………….............................
11. Visible Identification Mark: ……………………………………………………………………………………
12. Educational Qualifications:
(a) Qualification (eg. BE/ B Tech/ BSc etc)
…………………………………………………............................
(b) Discipline (eg. B Sc Chemistry/ B Tech (Electronics))………………………...
………………………….
(c) Name of College & Place…………………………………………………………………………………..
 (d) Name of University &
Place……………………………………………………………………………….
(e) Likely date of Final Results in DD/MM/YYYY format (For appearing students)….……………..
………
(f) Semester / Year wise marks:- (in qualifying exam)
Semester/ Maximum Marks % of Marks Semesters Maximum Marks % of Marks
Year Marks Obtained Marks Obtained
I V
II VI
III VII
IV VIII
Total

13. Passed 10+2 with Maths and Physics as subjects: ………………………………………..…Yes/No

14. (a) Appeared in SSB earlier for Army/Navy/Air force/Coast Guard………………………....Yes/No
(b) Appeared PABT earlier……………………………………………………………………Yes/No
(c) Results of PABT (If applicable)………...........................................................................Pass/Fail

15. NCC Air Wing (Sr. Div) ‘C’ Certificate …………………………………………….……......Yes/No

16. Original valid Commercial Pilot License issued/ validated by DGCA(India)………………..Yes/No

DECLARATION
1. I hereby declare that all the statements made in the application are true to the best of my knowledge
and belief.
2. I have never been debarred from appearing in any examination nor, have I ever been withdrawn from
Defence Training Establishments on disciplinary grounds, nor have I ever arrested, prosecuted or
convicted by criminal court or involved in any other case registered by the police.
3. I undertake not to make any claim for compensation if at any stage of my selection, my ineligibility
for candidature is detected and my candidature is cancelled as a result thereof.
4. This is only application submitted by me for 8 SSC (MEN)/ 37 SSC (WOMEN) Courses.
5. I am aware that any willful misrepresentation of facts and concealment of information will result in
cancellation of the candidature and may debar permanently or for a specific period from applying for
future courses.
6. Certified that I have read and understood the advertisement and fulfill the stipulated eligibility
criteria. I understand that my candidature is liable to be cancelled at any stage in case any discrepancy
is noticed.

Place: _________
Date: ___________
LEFT THUMB IMPRESSION FOR MEN/ SIGNATURE OF APPLICANT
RIGHT THUMB IMPRESSION FOR WOMEN