6/30/13

:: ONLINE APPLICATION ::

Application No. : 114/149406

INDIAN COAST GUARD ONLINE APPLICATION FORM Roll No. : NOG/NO/B/114/19496

(1) Name of the post applied for : Asst. Commandant General Duty (2) Centre at which you wish to appear for Test :- COAST GUARD SELECTION BOARD NOIDA A-1, SECTOR-24, OPPOSITE HCL TECHNOLOGIES DIST GAUTAM BUDH NAGAR, NOIDA, UP-201301 Date and Time of Reporting at Centre : 08 Jul 2013 Time 08:00:00 Priority 1 Centre Name Full Address of the Centre

Affix recent passport size colour Photo

COAST GUARD SELECTION BOARD NOIDA A-1, SECTORNOIDA 24, OPPOSITE HCL TECHNOLOGIES DIST GAUTAM BUDH - NO NAGAR, NOIDA, UP-201301

(3) Name of the candidate (as in Matriculation) SHEKHAR MAURYA Gender : Male (4) Current postal address: 1115,MAURYA HOUSE,NEAR PANCHSHEEL SCHOOL,TRANSFORMER WALI GALI,GANESHNAGAR, NEKPUR,BAREILLY, CITY: BAREILLY, STATE: UTTAR PRADESH, DISTRICT : BAREILLY, PIN : 243001 (5) Permanent address: 1115,MAURYA HOUSE,NEAR PANCHSHEEL SCHOOL,TRANSFORMER WALI GALI,GANESHNAGAR, NEKPUR,BAREILLY, CITY: BAREILLY, STATE: UTTAR PRADESH, DISTRICT : BAREILLY, PIN : 243001 (6) E-mail ID : sm6511@gmail.com (7) Mobile No : +919958572768 (8) Father's name : MOHAN LAL MAURYA (9) Category OBC (10) Date of Birth 07 Jul 1990 (11) Nationality : Indian (12) Qualification Qualification 12th Board/Institution CBSE AggrPercent 86 Compl. Compl. Year of Subject Mark Passing Physics 95 2008 Maths 95 2008

DR. B.R. AMBEDKAR Graduation(Other NATIONAL By Recognised INSTITUTE OF University) TECHNOLOGY, (REC), JALANDHAR

65.11

--NA--

2013

(13) Knowledge of Swimming : NO (14) Proficiency in sports, National Level (attach photocopies of certificate) : NO (15) NCC certificate obtained (attach photocopy of certificate, if yes) : --NA-www.joinindiancoastguard.gov.in/Report.aspx?xEtoEMkEsoDDDNmf7xl/2iM8U7hNCt5B 1/2

6/30/13

:: ONLINE APPLICATION ::

(16) Marital Status : Unmarried (17) Declaration : I, hearby solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief. I fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me. Place : Date : BAREILLY 30/06/2013
Print

Signature : Name of the Applicant : SHEKHAR MAURYA

www.joinindiancoastguard.gov.in/Report.aspx?xEtoEMkEsoDDDNmf7xl/2iM8U7hNCt5B

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