Registration Date:11-09-2016 11:57 AM Print Date:26-06-2017 10:10 PM

INDIAN ARMY
Directorate General of Recruiting
SSC(JAG)-19/900805

JAG Application Details

MY
AR
Personal Details
1. Roll No ANSSC(JAG)-19/900805
2. Post Applied For SSC(JAG)-19
3. Candidate's Name (As per Matric KESHAV TAK
Certificate)
DI

4. Father/Guardian Name ARVIND KUMAR TAK

5. Mother's Name SUNITA TAK
IN

6. Date of Birth (As per Matric Certificate) 12-10-1990

7. Nationality INDIAN
8. Gender Male
IN

9. Marital Status Unmarried

10. Mobile No 9001392379
JO

11. Email Address keshavtak@gmail.com

12. Aadhar
13. Permanent Address Correspondence Address
Address Tak BhAWAN NEAR Address Tak BhAWAN NEAR
PUSHKAR PUSHKAR
ROAD,KOTRA ROAD,KOTRA
AJMER RAJASTHAN AJMER RAJASTHAN
305004 305004
City / Town / Village AJMER City / Town / Village AJMER
District Ajmer District Ajmer
State Rajasthan State Rajasthan
PIN 305004 PIN 305004
14. SSB Details
(a) Entry (b) Location (c) Year/Month (d) Result
SSC(JAG) ALLAHABAD December-2016 Not Recommended
15. Education Details
(a) Year of Passing LLB 2016
Registration Date:11-09-2016 11:57 AM Print Date:26-06-2017 10:10 PM

INDIAN ARMY
Directorate General of Recruiting
SSC(JAG)-19/900805

(b) Total Marks 10.00

(c) Marks Obtained 6.34
(d) Marks Percentage Obtained 63.40
(e) Name of College/Institute IIT KHARARPUR
Address IIT KHARAGPUR
RSSOIPL

MY
City / Town KHARAGPUR
State West Bengal

AR
District Paschim Medinipore
Pin 721302
16. BAR Council Certificate AN No
17. Whether Collage/University recognized Yes
by Bar Council of India for LLB Course
DI

18. List of Documents to be taken for SSB:-

(a) One copy of the Print out of application duly signed and affix photograph self attested.
IN

(b) Self attested copy of Matriculation or equivalent certificate for age proof.
(c) Self attested copy of 12th Class Certificate & Marks sheet.
(d) Self attested copy of graduation Degree/Provisional Degree (in case of three years LLB
after graduation).
IN

(e) Self attested copy of LLB Degree/Provisional Degree.

(f) Self attested copy of Marks sheets of all years/Semesters.
JO

(g) Self attested copy of registration with Bar Council of India/State/Certificate from
college/University that the LLB Course in the said institution is recognized by Bar
Council of India.
(h) All certificates in original. Originals will be returned after verification at the Service
Selection Board itself. Any candidate who does not carry these entire documents for the
SSB interview, his candidature will be cancelled.
(j) The second copy of the printout of online application is to be retained by the candidate
for his reference. No need to send any hard copy to DG Recruiting.
(k) Candidates must submit only one application. Receipt of multiple applications from the
same candidate will result in cancellation of candidature.
Declaration
1. I hereby declare that all the statements made in the application are true to the best of
my knowledge and belief.
2. l have never been debarred from appearing at any examination nor have l ever been
withdrawn from OTA on disciplinary grounds, nor have I ever been arrested, prosecuted
or convicted by criminal court or involved in any other case registered by the police.
3. I undertake not to make any claim or compensation if at any stage of my selection, my
ineligibility for candidature is detected any time my candidature is cancelled as a result
Registration Date:11-09-2016 11:57 AM Print Date:26-06-2017 10:10 PM

INDIAN ARMY
Directorate General of Recruiting
SSC(JAG)-19/900805

4. This is the only application submitted by me for Judge Advocate General, Dept/Short
Service Commission and if any duplicate application is detected, my candidature be
cancelled and I may be debarred permanently from applying for commission in the
Armed Force.
5. Any wilful misrepresentation of facts and concealment of information will result in
cancellation of my candidature and may also debar me either permanently or for a
specified period from applying for future course.

MY
6. I affirm that all information supplied by me as above is true and correct, I also fully

AR
understand that if at any stage, it is discovered that any attempt has been made by me to
wilfully conceal or misrepresent that facts, my candidature may be summarily rejected or
employment terminated.
AN
Place:
Date:20-02-2017 04:25 PM
DI
IN
IN

Signature of Applicant
JO