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ApplicationRegistrationNo:64003245135fortheMultiTasking(NonTechnical)StaffInDifferentStates/UTs,2016
YourApplicationisCompleted
1.&1.1.NameofCenterandCenterCode: CRVaranasi(3013)
CRAllahabad(3003)
CRGorakhpur(3007)
2.CandidateName: RAJATKUMARSINGH
3.Father'sName: JAGDISHSINGH
4.Mother'sName: SHIVDEVI
5.DateofBirth(dd/mm/yyyy): 25/07/1996
6.Age(ason01.08.2017): 21.0
7.Nationality: Indian
8.Gender: Male
9.Category: General
10.WhetherPH(PWD): No
10.Ifyes,indicatecode:
10.1.WhetherExServiceman?: No
10.2.ForExServicemanLengthofService(inyears):
10.2.Dateofdischarge(dd/mm/yyyy):
11.WhetherseekingAgerelaxation?: No
11.1.Ifyes,indicatecode:
12.Whethersufferingfromcerebralpalsy?:
12.IfVH/CerebalPalsycandidate,whetherscribeisrequired?
13.ifyesindicatemedium:
14.WhetheryoubelongtoReligiousMinorityCommunity?: No
15.AadharCardNumber(Ifavailable):
16.MarkofVisibleIdentification: MOLEONMIDDLEFINGEROFLEFTHAND
17.State/UTCode: F21YMG5DJ67CEBAIXXXXXXXXXXXXXXXXX
18.EducationalQualification: 12thPass
19.DetailsofWorkExperience:
Periodof Periodof
Nameoftheorganisation Designation NatureofDuty(ies) Service Service
From(mm/yyyy) To(mm/yyyy)
VILLPRATAPPATTIPOSTHARAHUADIST
20.PostalAddress:
VARANASI
Village/City: PRATAPPATTI
District: VARANASI
State: UttarPradesh
Pincode: 221105
VILLPRATAPPATTIPOSTHARAHUADIST
21.Permanent/DomicileAddress:
VARANASI
State: UttarPradesh
Pincode: 221105
STDCode:
PhoneNumber:
MobileNumber: 8400728092
EmailID: rajatsinghvns5@gmail.com
22.Photo 23.Signature

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24/01/2017 164.100.129.99/mts/pdfprint/verifyprint.jsp

PaymentDetails:
Transactionid: CP71543329
TransactionDate(yyyymmdd): 20170124
Amount: 100
Declaration
Iherebydeclarethatallthestatementsmadeinthisapplicationaretrue,completeandcorrecttothebestofmyknowledgeand
belief.Iunderstandthatintheeventofanyinformationbeingfoundsuppressedfalseorincorrectorineligibilitybeingdetected
beforeandafterexamination,mycandidature/appointmentisliabletobecancelled.
Place:
Date(yyyymmdd):20170124
SignatureofCandidate

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