Staff Selection Commission

(Block No. 12, CGO-Complex, Lodhi Road, New Delhi

110003 )
Combined Graduate Level Examination-2017
Registration No: 60003523790

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code

NR-Delhi(2201) 2201
NR-Haridwar(2005) 2005
NR-Dehradun(2002) 2002
Candidate's Full Name Father's Name Mother's Name Date of Birth
SOURABH GOEL MAHINDER GOEL ASHA GOEL 1997-09-22
Gender Nationality Fee Category
Male Indian Fee Paid General
Whether Ex-serviceman If,ExS,whether seeking Length of Service Date of Discharge
reservation?
No
Whether PH? If yes,indicate code Whether seeking Age If yes,indicate code Age as on (01.08.2017)
relaxation?
No No 19.10
Preference for Group of Are you applying for the Do you possess EQ for the Are you applying for the Do you possess EQ for the
Posts: Posts of Junior Statistical Posts of Junior Statistical Post of AAO? Posts of AAO?
Officer? Officer?
BCAD No No No No
Whether belong to Minority If VH/Celebral Palsy/Locomotor If yes,indicate medium Mark of visible identification
Communities as per Govt. Orders? candidate,whether scribe is
required?
No No CUT MARK ON CHEST
Mode of Fee Payment Amount Transaction-ID Transaction Date
Online 100 IK00EPHIR9 2017-05-19
Educational Qualiication(Please note that possession of Graduate Qualification is a pre-requisite to apply for this examination,However you may
indicate your highest qualification) Indicate Code
B.Tech

Do you want to make available your personal information for accessing job opportunity in terms of Dop&T's O.M
No.39020/1/2016-Estt.(B) dated 21.06.2016?
Yes

Details of Work Experience/Govt. Service rendered

Name of the Organization Designation Nature of Duty(ies) Period of Service
-

Address Detail
Communication Address Permanent Address
H NO 5/543 INDIRA COLONY H.NO.5/543 INDIRA COLONY NEAR SHIV MANDIR SONIPAT
131001 HARYANA INDIA
City: NEAR SHIV MANDIR State: Haryana
District: SONIPAT Pin Code: 131001
State: Haryana Mobile No.: 9255406055
Pin Code: 131001 Email Id: mohindergupta3@gmail.com

Declaration
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