son22016 ZpHlome Ce PERSONAL DETAILS 1, POST APPLIED FOR 2, TEST CENTER CITY 1 3. TEST CENTER CITy 2 4, TEST CENTER CITY 3 5. TEST CENTER CITY 4 6. TEST CENTER CITY 5 7. DOMICILE STATE 8. CATEGORY APPLIED 9. APPLICANT FULL NAME [APPLICANT FATHER'S / HUSBAND'S NAME 12, GENDER 14, PRESENT ADDRESS 15. PERMANENT ADDRESS 16. MOBILE NO 17, ACTIVE EMAIL ID 18, DATE OF BIRTH 20, NATIONALITY EDUCATIONAL QUALIFICATION NAME OF THE ‘SNo_ QUALIFICATION — UTTAR PRADESH POWER COF ‘GRADUATION Pec. toro Login 1135200 OFFICE ASSISTANT GRADEAI VARANASI Lucknow Auaiagao ‘ KANPUR t if cree Beli aii UTTAR PRADESH (08C(NON CREAMY LAYER) CHAKRAVARTI SINGH RAMBHAROSE SINGH 11, APPLICANT MOTHER NAME NIRMALA wave 13, NARITAL staTUS unmansieD ADDRESS LINE WARD NO 14 HOUSE NO 118 ADDRESS LINE2 TAIGORE NAGAR ADDRESS LINES AOBERTSGAND STATE UTTAR eRADEst bistRict SONBHAORA pin cove aaiais POLICE STATION ROBERTSGAND ADDRESS LINES WARD NO 14 HOUSE NO 118 ADDRESS LINE2 TAIGORE NAGAR ADDRESS LINES AOBERTSGAND stave UTTAR pRaDest bsrRict SONBHADRA pin cove aaiais PoLICE STATION OBERTSGAND yo7sosa4s8 chalravartisingh02@5ma 2a Yeas 1 1/0s/1992 18, TOTALAGE onthe 12 Days INOIAN veanor — NANEOF ceaminicare INSTITUTION/BOARD ROLL NO PERCENTAGE NO (NON. hp/03.12.98‘IUPPCLSTENOleanddalePrint inal aspx weson22016 DEGREE PASSING 1 1OtR(HIGH SCHOOL’ * EQUIVALENT 2007 12th 2 (INTERMEDIATE ~ 2009 EQUIVALENT COMPUTER 3 DEGREE SCIENCE AND 2014 ENGINEERING PAYMENT STATUS. PAYMENT MODE ‘TRANSACTION REF. NUMBER ONLINE PAYMENT UPPCLDECL6-0162994 DECLARATION uPPet JUNIVERSITY UTTAR PRADESH yorar 2829503 UTTAR PRADESH oan 1875467 vueru : STATUS. Completed Successfully MANDATORY) 66.50 69.00 67.84 | hereby declare that I have read all the terms and conditions mentioned jn the advertisement and General Institutions for the Candidates and I fulfil and abide myself with conditions given in both the acvertisement and General Instructions, Further, I hereby declare that the information provided in the application Form is true, complete & correct to the best of my knowledge and belief. I have nt concealed any information. In case, any fact mentioned in the application is found to be wrong/ incorrect at any later stage, my candidature, selection and appointment may be canceled. Date : 30-12-2016 hip 03.12.98‘ IUPPCLSTENOlcanddalePrinl inal aspx ee Print Signature