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Staff Selection Commission

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


COMBINED HIGHER SECONDARY LEVEL (10+2)
EXAMINATION-2017
Registration No: 60001738251

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code


CR-Allahabad(3003) 3003
CR-Kanpur(3009) 3009
CR-Varanasi(3013) 3013
Candidate's Full Name Father's Name Mother's Name
PANKAJ KUMAR SINGH DHIRENDRA PRATAP SINGH PUSPA DEVI
Date of Birth Gender
1994-05-06 Male
Nationality Fee Category
Indian Exemption claimed OBC
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?
Yes VH Yes Hindi
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)?
24.3 Hindi Yes
Mark of visible identification Whether belong to Minority Communities?
CUT MARK ON RIGHT HAND KALAI 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.Sc.

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
BIGAHANI BIGAHANA MEJA ALLAHABAD VILL BIGAHANI POST BIGAHANA SIRSA MEJA ALLAHABAD
City: BIGAHANI State: Uttar Pradesh
District: ALLAHABAD Pin Code: 212305
State: Uttar Pradesh Mobile No.: 9936591729
Pin Code: 212305 Email Id: pankajkumarsingh212305@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)01/08/2018 14:48:40

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