Staff Selection Commission

Block No. 12, CGO-Complex, Lodhi Road, New Delhi 110003

COMBINED HIGHER SECONDARY LEVEL (10+2)
EXAMINATION-2017
Registration No: 64012586486

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code

SR-Guntur(8001) 8001
SR-Hyderabad(8601) 8601
SR-Warangal(8603) 8603
Candidate's Full Name Father's Name Mother's Name
ANKAM ROSAIAH ANKAM YESUPADAM ANKAM NAGESWARI
Date of Birth Gender
1990-06-15 Male
Nationality Fee Category
Indian Exemption claimed SC
If Ex-serviceman Length of Service Date of Discharge If, ExS, Whether eligilble for
reservation?
No
Whether PH? If yes,indicate code If Cerebral Palsy? Do you suffer from If VH/Cerebral Palsy/ If yes, indicate
Locomotor Disability Locomotor whether medium
(40% or more) scribe is required?
wherein the dominant
writing extremity is
affected to the extent
of slowing down the
performance?
No
Indicate Age relaxation code Age as on 01.08.2018 Indicate medium for Typing Test Do you possess educational
qualification of 12th standard pass
in Science stream with
Mathematics as a subject from a
recognised Board or equivalent
(for DEO in C&AG)?
SC/ST 28.1 English Yes
Mark of visible identification Whether belong to Minority Communities?
A MOLE ON THE RIGHT LEG No
Mode of Fee Payment Amount Transaction-ID Transaction Date

Educational Qualification (Please note that possession of Intermediate/Higher Secondary/12th Standard Qualification is
a pre-requisite to apply for this examination,However you may indicate your highest qualification)
B.Tech

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

Address Details
Communication Address Permanent Address
D NO.1/203 THULLUR POST AND MANDAL GUNUR DIST D.NO 1/203 THULLUR POST AND MANDAL GUNTUR DISTRICT
 City: THULLUR State: Andhra Pradesh
District: GUNTUR Pin Code: 522237
State: Andhra Pradesh Mobile No.: 9493148195
Pin Code: 522237 Email Id: rosaiah.403@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

Printed on:(mm/dd/yyyy)12/10/2017 22:03:32