11/8/2016

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ApplicationRegistrationNo:63002970662fortheCombinedHigherSecondaryLevelExamination2016
YourApplicationisCompleted
1.&2.NameofComputerBasedwrittenExaminationCenterandCode:
SRCoimbatore(8202)
SRTiruchirapalli(8206)
SRMadurai(8204)
3.CandidateName:
RANJITHKUMAR
4.Father'sName:
THANGAM
5.Mother'sName:
EASWARI
6.DateofBirth(dd/mm/yyyy):
24/10/1996
7.Gender:
Male
8.Nationality:
Indian
9.FeeExemptionclaimed:
FeePaid
10.Category:
OBC
10.1.WhetherExServiceman?:
No
10.2.ForExServicemanLengthofService(inyears):
10.2.Dateofdischarge(dd/mm/yyyy):
10.3.WhethereligibleforExServicemanReservation?:
11.WhetherPH(PWD):
No
11.1.Ifyes,indicatecode:
11.2.Whethersufferingfromcerebralpalsy?:
11.2.IfVH/CerebalPalsycandidate,whetherscribeisrequired?
11.3.ifyesindicatemedium:
12.WhetherseekingAgerelaxation?:
No
12.Ifyes,indicatecode:
12.1.Age(ason01.01.2017):
20.2
13.Preferenceforposts:
PDELC
14.IndicatemediumforTypingTest:
English
14.1.DoyoupossessknowledgeofTypingTest?:
Yes
15.AadharCardNumber(Ifavailable):
711319994521
16.MarkofVisibleIdentification:
17.WhetheryoubelongtoReligiousMinorityCommunity?:
No
18.EducationalQualification:
Intermediate/HigherSecondary/12thStandard
19.DoyouwanttomakeavailableyourpersonalInformationforthe
accessingjobopportunityintermsofDoP&T'sO.M.No.39020/1/2016Estt. Yes
(B)dated21.06.2016?:
20.PostalAddress:
KARAIYAMPATTYNAGAYAKOTTAIPOST
Village/City:
VEDASANDURALUK
District:
DINDIGUL
State:
TamilNadu
Pincode:
624706
6/21KARAIYAMPATTYNAGAYAKOTTAIPOST
21.PermanentAddress:
VEDASANDURTALUKDINDIGUL
State:
TamilNadu
Pincode:
624706
STDCode:
PhoneNumber:
MobileNumber:
9597924290
EmailID:
ranjith24101996@gmail.com
23.Photo
24.Signature

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11/8/2016

164.100.129.99/chsl/pdfprint/verifyprint.jsp

PaymentDetails:

Transactionid:
TransactionDate(yyyymmdd):
PaymentMode:
Amount:

IK00ABILI5
20161108
online
100

Declaration

Iherebydeclarethatallthestatementsmadeinthisapplicationaretrue,completeandcorrecttothebestofmyknowledge
andbelief.Iunderstandthatintheeventofanyinformationbeingfoundsuppressedfalseorincorrectorineligibilitybeing
detectedbeforeandafterexamination,mycandidature/appointmentisliabletobecancelled.
Place:
Date(yyyymmdd):20161108
SignatureofCandidate

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