STA

AFF SELECTION CO
OMMISS
SION

ANNEXU
UREI

,2
2011
CIENTIFICASSISTTANTIN
NINDIAN
NMETEO
OROLOG
GICALDE
EPARTM
MENT,20
011
SC
BE{ {F BE x] nA MAA +xn / BE BBvx {BBE {f * BD (

) Jx BE A x
BE {x BE
B |M *

Pleease read insstructions iin the Noticce of the Exaamination/A

Annexures carefully. U
Use Blue or Black ball pen
p to writee in the box (

1.. {F BExp BE x / Nam

me of the Exaamination Ceentre
2. {F BE
B xp BEb /Examination Ceentre Code

3. =nB BEE { x (+OV ) ]BE
E x |h {{j nA MA x BE +x +F J * x BE n M BE S ABEE BD BE J U n *

Candidatees Full Nam

me (in English). Write in Capital Lettters exactly as in Matricculation Certtificate. Leav
ve one box blank
b
betweeen every two parts of the name.

4.{i BE x (+OV BE
+F JJ) / Fatherrs Name (W
Write in Cap
pital Letterrs in English
h)

5.. i BE x (+OV BE +F J) / Motheers Name (Write

(
in Caapital Letteers in Englissh)

6.Vx BE iJ
J/ Date of Birth

n x/ Daycxx /Month /Yearr

10.gh/Category
(JJ 9-+x,1 +V,2 +VV AB 6-++{B)
(Wrrite 9-Generaal, 1-SC, 2-ST
T,
6-OBC)

8. /Nationality
(J
J 1-i AB 2-+x
2
)
(Wriite 1-Indian & 2 - Others)

7.M/Gendeer

(JJ 1-j AB 2-{)

(W
Write 1-Femalee & 2- Male)

10.1 +{ ii{B xBE c ?

an
If Ex-servicem
E
3 J
Write 3 in the boox

9.BE/Fee
(J 1-BE BE Mix n 2- U] BEE nB BE)
(Writte 1-Fee paid
d & 2- Exemption

10.2.i {B xBE BE AFor Ex-Serviceman

B +Bv / Length of Service

11. BD +{{ BE BBEEM c ?

Whether PH ?

[ /Year]

(J 1-c ABB 2-xc)

B {ii il/Date off Discharge

(Wrire 1-Y
Yes, 2-No)
((nx/Dayccx /Month /year)

11.11n c, BEb +BEi BE 12.BDD + U] Sci c?

?
112.1n c, BBEb

Iff yes, indicaate code

Wheether seekin
ng Age relaxxation ?

(JJ 4-+.B., 5-g.B.)

(Wrrite 4-OH, 5-H
HH )

(J 1-c AB 2-xc)(Write -1-Y

Yes, 2-No)

++BEi BE
If yes,
iindicate cod
de

12
2.228.10.20
011 BE + /Age as on
n 28.10.20111

/ Years cx/ Months

M
nx// Days

13.BD +{ +{JBE c?

(J 1-c AB 2--xc)
Whether belong to Minority C
Communitiess ? (Write 1-Y
Yes, 2-No)
14.

/ -

BE |lBEi Preference
P
forr State/U.T.[S
See Para-14 P
Preference-coodes for States/UTs]
123456789101111213141516171819202122232
24

15.FBE Mi Educational Qualificatioon

BEb +BEi BE Indicate Coode [See Paraa-5]

Su
ubject Code

+BE BE |ii (%)

Perrcentage (%) of Marks

v (+OV
V -1, cxn-2 B +x-3)
+

Meedium ( Engliish-1, Hindi-2

2, Others-3)

16.BE +xBB BE BBh Details off work Exp

perience / Govt. Servvice
l
l BE x
Nam
me of the O
Organisation
n(s)

{nnx

BE BE BBBh
Naame of the Duty(ies)
D

Desiggnation

17. {i: +{x x ci {j BBc BE { {i

{ +OV BE +F
cxn x
BE {x J *
Ad
ddress: Writte your com
mplete Comm
munication Address including you
ur
Nam
me in English Capital L
Letters or Hindi
H
with B
Blue or Blacck Ball Pen..
Name__
_______________________________________________________

Address_
______________________________________________________

__________________________________________________________________
__________________________________________________________________

PIN:

./M
Mobile No. : .........................................................
/Emaill ID:

...

..

1 . {E]O{E
18
4 x 5 +BEE BE
c c JS M {EE] O{E
c ~BE
B fM S{BBE *
(]{ x BE * {E]
] BE
i{i x BEBAA)
P
Photograph
Paste heree firmly you
ur recent
p
photograph
(4 c.m.X 5c.m
m)
ot get the
(Do not sttaple. Do no
Photoograph attestted)

BEE BE +Sv /
Period
d of Service
/From iBEE/ To

BE |M ci)
++xEBE (BEB
Rooll Number (for
( Office use
u only)

19.=nB BE ciF (BEB P] ci{

)
Signaature of the Candidate
iin the left Box
B (Only in
i running
H
Hand)
(P
Page 1 of 2)

20. /Declaration

(i ) /

I have not submitted any other application for this examination. I am aware that if I contravene
this rule, my application will be rejected summarily by the Commission.
(ii) , /
I have read the provisions in the Notice of the examination carefully and hereby undertake to
abide by them.
(iii) / , ,
/
I further declare that I fulfill all the conditions of eligibility regarding age limits, educational
qualifications etc., prescribed for admission to the examination.
(iv) / /
/

I also declare that I do not stand debarred by SSC/UPSC as on date and have never been
convicted by any court of law. I also declare that no charge sheet is pending against me in any
court of law. Further declare that I have never been dismissed or removed from Govt. Service or
my service been terminated during probation.
(v) *
/ 3
,
* For Central Govt. Civilian Employee seeking age relaxation.
I declare that I am a Central Govt. Civilian Employee and completed 3 years of regular service or
regular length of service stipulated in the Notice of the examination on or before date of closing
of submitting application form given in the Notice.
(vi) *
/ 8.9.1993
36012/22/93- ( )

, . 3 / ( )
/
/
*For Candidate belonging to OBC.
I declare that I belong to the community which is recognized as a backward class by the Govt.
of India for the purpose of reservation in services as per order contained in Deptt. of Personnel
and Training Office Memorandum No.36012/22/93-Estt.(SCT) dated 8.9.1993. I also declare that
I do not belong to the person/sections (creamy layer) mentioned in column 3 of the schedule of
the OM mentioned above and modified vide Govt. of India DOPT OMs mentioned in the Notice. I
further declare that I am in possession of OBC Certificate in the prescribed format given in the
Notice of the examination or will submit valid OBC Certificate at the time of Interview as per the
provision of the Notice.
(vii)
/ /
For Candidate belonging Ex-Serviceman
I declare that I fulfill all the eligibility condition relating to Ex-Serviceman as per notice of
examination.
(viii) /
, / /
/
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.

=nB BE ciF (BEB P] ci{ )

Signature of candidate ( only in running hand)

lx/Place: ..

iJ/Date:
* n M x c i c <x BE] n *
*Strike off this sentence if not applicable

+ciFi +Bnx {j BE q BE n VM
Unsigned application will be rejected