Application of Job: PC [10PLUS 2 BTECH] - 06/2017

Application No: PCT176M001494 Application Date: 13/12/2016

PRIORITY

1. PC [10PLUS 2 BTECH] 06/2017

PERSONAL PARTICULARS

Name: RAHUL SINGH

Father's Name: SUBHASH SINGH
Guardian's Name: SUBHASH SINGH
A MOLE ON RIGHT SIDE OF
Identification Mark 1:
NOSE
A INJURY MARK ON RIGHT
Identification Mark 2:
CHICK
Nationality: INDIAN
Aadhaar No.: ---------
Date of Birth: 05/04/1999

EDUCATION PARTICULARS

Details of 12th Qualification

Percentage based on 73.33%

Subjects Total Marks Obtained Marks
PCM marks:
Physics 100 77

Chemistry 100 84

Maths 100 59

12th English Marks 100 85

10th English Marks 100 76

Appeared for JEE NO

Ranking?:
Serial no. of
949807
Marksheet:
State Conducted Board Conducted
UTTARAKHAND CBSE
Exam: Exam:

Details of 10th Qualification

State Conducted Board Conducted Serial no. of
UTTARAKHAND CBSE 1335590
Exam: Exam: Marksheet:

MILITARY RECORD

Have you ever been enrolled in Armed Forces before?: NO

Have you attended any Services Selection Board (SSB)
NO
before?:
Have you been discharged from Armed forces before?: NO

COMMUNICATION PARTICULARS

Details of Permanent Address

Address 1: VILL.- KOYAL , P.O.- DHANAURI, Address 2: TEH. - NARWANA

State: HARYANA District: JIND Pincode: 126116
Domicile: HARYANA Phone No.: 8077129828 Mobile No.: 7500333324
Email id: me.coolrahulsingh@gmail.com Alternate Email id: me.coolrahul@outlook.com

Details of Correspondence Address

Address 1: L-115, SHIVALIK NAGAR, Address 2: B.H.E.L,

State: UTTARAKHAND District: HARIDWAR Pincode: 249403
Alternate Mobile Number: 7500333324

A. I hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of Indian and
have never been debarred from appearing at any examination. I have never been arrested/ prosecuted and convicted by a
criminal court or involved in any other case registered by the Police.
B. I hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my
knowledge and belief.
C. I fully understand that in the event of my information being found false or incorrect, appropriate action can be taken
against me.
D. Eligibility criteria will be verified on reporting at the selection centres. I found ineligible, I understand that criminal
proceedings can be initiated against me for fraudulent entry and falsification of Government of Indian documents. I also
accept that no TA/ DA will be admissible to me in such cases.