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Staff Selection Commission

Block No. 12, CGO-Complex, Lodhi Road, New Delhi 110003
Recruitment of Combined Graduate Level Examination, 2018
Registration No: 64016420580

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code
CR-Muzaffarpur(3205) 3205
CR-Patna(3206) 3206
CR-Varanasi(3013) 3013

Candidate's Full Name Father's Name Mother's Name Date of Birth
SHASHI RANJAN SEO KUMAR TIWARY ANJU DEVI 1995-01-08

Gender Nationality Fee Category
Male Indian Not Exempted General

Fee Option Amount Transaction-ID Transaction Date
100 CPH5172136 2018-06-04

Whether Ex-serviceman Length of Service (in years) Date of Discharge If ExS, Whether eligilble for
reservation
No

Whether If yes,type Do you Do you suffer from Locomotor Whether scribe is If yes,
Person with of suffer from Disability (40% or more) wherein the required in case of indicate
Disability disability(O Cerebral dominant writing extremity is affected VH/Cerebral medium
(PwD)? H,HH,VH,O Palsy (40% to the extent of slowing down the Palsy/Locomotor
thers) or more) ? performance? Disability (40% or
more)?
No

Age as on (01.08.2018) Whether seeking Age relaxation? Age Relaxation code
23.6 No

Are you also applying for the Do you possess EQ for the Whether belong to Minority Mark of visible identification
Post of Junior Statistical Post of Junior Statistical Communities as per Govt.
Officer ? Officer ? Orders?
No No No A CUT MARK ON LEFT
FORHEAD

Educational Qualification (Please note that possession of Graduate Qualification is a pre-requisite to apply for this
examination,However you may indicate your highest qualification)
B.Sc.(Hons.)

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?
No

Address Detail
Communication Address Permanent Address
S/O-SEO KUMAR TIWARY S/O- SEO KUMAR TIWARY VILL- ANANTPUR PO- BERATH PS-
CHAURI DIST- BHOJPUR
City: ANANTPUR PO BERATH State: Bihar
District: BHOJPUR Pin Code: 802201
State: Bihar Mobile No.: 9693778152
Pin Code: 802201 Email Id: ranjan.shashi0096@gmail.com

complete and correct to the best of my knowledge and belief. Declaration I hereby declare that all statements made in this application are true. 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): 06/04/2018 22:55:48 .