STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
CONSTABLE (GD) IN CAPFs, NIA, SSF AND RIFLEMAN
(GD) IN ASSAM RIFLES EXAMINATION 2018

REGISTRATION NO :75001076478

APPLICATION IS INCOMPLETE
1. CANDIDATE'S NAME 2. FATHER'S NAME 3. MOTHER'S NAME
BHOSALE SANKET PRAVIN PRAVIN BHOSALE NANDA BHOSALE
4. DATE OF BIRTH (DD/MM/YYYY) 5. AGE AS ON DATE (01/08/2018) 6. GENDER
17/03/1997 21.4 MALE
9. MARK OF VISIBLE
7. CATEGORY 8. NATIONALITY
IDENTIFICATION
BLACK MARK ON LEFT
UNRESERVED CITIZEN OF INDIA
CHIN
10. MATRICULATION (10th CLASS) 12. MATRICULATION (10th
11. MATRICULATION (10th CLASS) ROLL NO
EXAMINATION BOARD CLASS) YEAR OF PASSING
MAHARASHTRA STATE BOARD OF
SECONDARY AND HIGHER K050792 2012
SECONDARY EDUCATION
13. PREFERENCE OF EXAMINATION CENTER
PREFERENCE OF EXAMINATION CENTER CODE PREFERENCE OF EXAMINATION CENTER
7204 MUMBAI
7207 NASHIK
7202 AURANGABAD
14.WHETHER EX- 14.1. IF EXS, WHETHER 14.2. LENGTH OF SERVICE ( 14.3. DATE OF DISCHARGE
SERVICEMAN (ExS)? ELIGIBLE FOR IN YEARS )
RESERVATION?
NO - - -
15. WHETHER SEEKING AGE 15.1. IF YES,INDICATE CODE 16. STATE / UT OF 17. DISTRICT OF
RELAXATION? DOMICILE DOMICILE
NO MAHARASHTRA AURANGABAD
18. HAVE YOU MIGRATED FROM THE 18.1 WHETEHR YOU WOULD LIKE TO 18.2 WHETHER YOU WANT TO BE
STATE/ UT OF YOUR ORIGIN TO THE AVAIL RESERVATION FROM THE CONSIDERED AS A UR CANDIDATE
STATE/ UT WHERE YOUR CASTE IS STATE/ UT OF ORIGIN FROM THE STATE/ UT OF DOMICILE
NOT RECOGNISED AS SC/ ST/ OBC?
NO - -
18.3. STATE OF ORIGIN 18.4. DISTRICT OF ORIGIN 19. CANDIDATE BELONGS 20. CANDIDATE BELONGS
TO MILITANCY/ NAXAL TO BORDER DISTRICT
AFFECTED DISTRICT
- - NO NO

21. PREFERENCE OF POSTS FOR CAPF'S & ORGANISATIONS

BCDEFAGH
22. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
YES
23. EDUCATIONAL QUALIFICATION
DIPLOMA

ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
AT POST POKHARI, TEHSIL- VAIJAPUR, DIST- AT POST POKHARI, TEHSIL- VAIJAPUR, DIST-
AURANGABAD AURANGABAD

DISTRICT: AURANGABAD DISTRICT:AURANGABAD

STATE: MAHARASHTRA STATE: MAHARASHTRA
PINCODE: 431115 PINCODE: 431115
MOBILE NO: 8007095371 EMAIL: bhosalesanket77@gmail.com
SIGNATURE THUMB IMPRESSION

FEE AMOUNT TRANSACTION NO TRANSACTION DATE

NOT EXEMPTED 100 - -
DECLARATION
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: 14/09/2018 12:36:03 PM