Bihar

Public Service Commission, Patna

Advertisement No

56th to 59th combined competitive (Main) exam

.

56th to 59th CCE

Registration No: 5659010148

THE FORM MUST BE FILLED IN ENGLISH

01.
(i) Name:
(ii) / Fathers/Husbands Name:
(iii) Mothers Name:

RAVI RANJAN KUMAR

DINBANDHU THAKUR
NIRMALA DEVI

(v) Gender

Male:

(iv) Date of Birth:

(vi) Age as on 01/08/2010

Day 02 Month
Day 30 Month

08 Year 1975
11 Year 34

Age as on 01/08/2013

Day 30 Month

11 Year 37

02.
(i) Are you a citizen of India ?
?
(ii) Are you a permanent resident of Bihar ?
?
(iii) Do you belong from any Reserved Category ?
?
(iv) If yes then select the Category Code

Female:

Transgender:

Yes:

No:

Yes:

No:

Yes:

No:

EBC-04

03.
(i) Are you Physically Handicapped ?
?
If yes, Nature of Disability
,
Percentage of Disability

(ii) Are you Bihar Government Employee ?
?
If yes / Designation /
Of ice /
Place / Place
(iii) Are you an Ex-Serviceman ?
?
(iv)Do you have minimum required eligibility criteria as
mentioned in the advertisement ?
/ ?

Yes:

No:

1-Blind:

2-Deaf & Dumb:

1. More or equal to 40%:

Yes:

No:

Yes:

No:

Yes:

No:

3-Physical Handicap:

2. Less than 40%:

04. (i) Which language do you prefer to answer the Non Linguistic Subject ?
Hindi:
English: Urdu:

(ii) Optional Subject Code:
11 - And 16 -
05. Amount Deposited through Challan

06. Phone No. (With STD Code)

800:

Mobile No.
9334970415

250:
Email
Raviranjan.335@rediffmail.com

07. Address of Correspondence

Address Line 1: :
S/o dinbandhu thakur
Address Line 2: :
near anuradha vivah bhawan sir ganesh datt
Address Line 3: :
nagar bhagwanpur
State: :
Bihar
District: :
Parmanent Address

Same as above

Address Line 1: :
Address Line 2: :
Address Line 3: :
State: :

vill. - khrauna dih

p.o. - khrauna dih
p.s. - kurhani
Bihar
District: :

Muzaffarpur

Pincode: :

842001

Muzaffarpur

PinCode: :

843113

Registration No: 5659010148

08.
(i)Marital Status

Yes:

No:

(ii)Whether you read and write in Hindi ?

Yes:

No:

bar
09. Educational Quali ication
Exam Passed

Subjects

Secondary
Intermidiate/+2
Graduate General/Hons
Post Graduate

Session

math eng.science
science (math)
economics (hons.)
economics

1990-91
1991-93
1993-96
1996-98

Year Of
Passing

1991
1993
1997
2002

Institute

Board/University

m.s. motihari
m.s.college motihari
m.s.college motihari
m.s.college motihari

bseb patna
biec patna
brabu muzaffarpur
brabu muzaffarpur

Marks Full Marks

Obt.

442.00
596.00
420.00
446.00

900.00
900.00
800.00
800.00

49.11
66.22
52.50
55.75

10. Previous Employment Detail

Yes:
No:

Permanent /
Temporary

Name Of Post

Date Of
Joining

Date Of
Leaving

Reason for Leaving

Salary

Appointing Officer
(Designation)

/:
11. If Expelled/Ineligible declared by any Govt/BPSC/University/Other Exam Conducted by any Commission, If yes then Describe
/ / / /
Yes:

No:

Name of Exam

Year

Roll No.

Period Of ineligibility

Name and Address of the Punishing Officer

12. Description of places where candidate stayed more than 6 months in last 3 years
- ,
Sl#

Place of Stay

1 sir ganesh datt nagar

sir ganesh datt nagar bhagwanpur

2 muzaffarpur
3 sir ganesh datt nagar bhagwanpur

From

To

Full Address

22/11/2006 22/01/2016 near anuradha vivah bhawan sir ganesh datt nagar bhagwanpur muzaffarpur bihar
22/11/2006 22/01/2016 near anuradha vivah bhawan sir ganesh datt nagar bhagwanpur muzaffarpur
22/11/2006 22/01/2016 near anuradha vivah bhawan sir ganesh datt nagar bhagwanpur muzaffarpru bihar

13. Candidate's Height

. In Cm

In Feet

In Inch

170.00

0.00

0.00

14. Measure of Chest
Normal Condition

On Chest Expansion

. In Cm

In Inch

. In Cm

In Inch

83.00

0.00

88.00

0.00

15. ,
Address of two persons who knows the candidates more than 6 months, but not in relation *
(i) rajeev kumar jha chainpur bhagwanpur muzaffarpur
(ii) akhilesh kumar sir ganesh datt nagar bhagwanpur muzaffarpur
16. / 0ne body identi ication mark of the candidate:
a mole(til) on neck

Registration No: 5659010148

17. Any Other Information:

Yes:

No:

18. [ BPSC's Copy ]

Detail of the Exam Fee paid through Challan [BPSC's Copy attach with original]

[ . .]
State Bank of India Branch Code JOURNAL No Exam Fee Deposit Date Amount (Rs.)

18042

029002771

15/01/2016

800.00

19. Selected two Optional Subjects

Subject Code

11
16

Subject

/ | |
, / / / |
| |
I hereby declare that all the information given in the application above are true & correct. No information has been hidden by me. However, if, any
of the information given above, is found incorrect, I would be held responsible for that and I assure that legal/panel actions may be taken against
me and my candidature may be cancelled. For this, I would not have any objection. I am ready to follow all the rules of the commission.

Enclosures:(I)

Matric Certificate/Marksheet for DOB Certificate

(II)

Graduation Certificate & Marksheet

(III) Caste cetificate

(IV) Domicile Certificate
(V)

Non creamy layer certificate (Only for BC & EBC)

(VI) Copy of Original Bank Challan

(VII) Physically disabled certificate
(VIII) Other
: INSTRUCTION :

|
Applicant should sign at prescribed Boxes in the application & send with all the enclosures on the following address:
To
The Joint Secretary-cum-Examination Controller,
Bihar Public Service Commission,
15, Jawahar Lal Nehru Marg,
(Bailey Road), Patna -800001. Bihar
Candidate Signature

/ Date :
/ Place :

English:
In Hindi: