STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
CONSTABLE (GD) IN CAPFs, NIA, SSF AND RIFLEMAN
(GD) IN ASSAM RIFLES EXAMINATION 2018

REGISTRATION NO :71000224300

APPLICATION IS PROVISIONALLY SUBMITTED

1. CANDIDATE'S NAME 2. FATHER'S NAME 3. MOTHER'S NAME
AVULA NAVEEN AVULA VENKANNA AVULA ILAMMA
4. DATE OF BIRTH (DD/MM/YYYY) 5. AGE AS ON DATE (01/08/2018) 6. GENDER
07/05/1998 20.2 MALE
9. MARK OF VISIBLE
7. CATEGORY 8. NATIONALITY
IDENTIFICATION
A MOLE ON THE RIGHT
OBC CITIZEN OF INDIA
NECK
10. MATRICULATION (10th CLASS) 12. MATRICULATION (10th
11. MATRICULATION (10th CLASS) ROLL NO
EXAMINATION BOARD CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION
1531115749 2015
ANDHRA PRADESH
13. PREFERENCE OF EXAMINATION CENTER
PREFERENCE OF EXAMINATION CENTER CODE PREFERENCE OF EXAMINATION CENTER
8601 HYDERABAD
8008 VIJAYWADA
8001 GUNTUR
14.WHETHER EX- 14.1. IF EXS, WHETHER 14.2. LENGTH OF SERVICE ( 14.3. DATE OF DISCHARGE
SERVICEMAN (ExS)? ELIGIBLE FOR IN YEARS )
RESERVATION?
NO - - -
15. WHETHER SEEKING AGE 15.1. IF YES,INDICATE CODE 16. STATE / UT OF DOMICILE 17. DISTRICT OF
RELAXATION? DOMICILE
YES 02-OBC TELANGANA MAHABUBABAD
18. HAVE YOU MIGRATED FROM THE 18.1 WHETEHR YOU WOULD LIKE TO 18.2 WHETHER YOU WANT TO BE
STATE/ UT OF YOUR ORIGIN TO THE AVAIL RESERVATION FROM THE CONSIDERED AS A UR CANDIDATE
STATE/ UT WHERE YOUR CASTE IS STATE/ UT OF ORIGIN FROM THE STATE/ UT OF DOMICILE
NOT RECOGNISED AS SC/ ST/ OBC?
NO - -
18.3. STATE OF ORIGIN 18.4. DISTRICT OF ORIGIN 19. CANDIDATE BELONGS 20. CANDIDATE BELONGS
TO MILITANCY/ NAXAL TO BORDER DISTRICT
AFFECTED DISTRICT
- - NO NO

21. PREFERENCE OF POSTS FOR CAPF'S & ORGANISATIONS

ABECDGFH
22. 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
23. EDUCATIONAL QUALIFICATION
DIPLOMA

ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
HNO;2-52 UPPARAPALLI HNO;2-52 UPPARAPALLI
VILLAGE,UPPARAPALLI,KESAMUDRAM VILLAGE,UPPARAPALLI,KESAMUDRAM
MANDAL,WARANGAL MANDAL,WARANGAL
DISTRICT: MAHABUBABAD DISTRICT:MAHABUBABAD
STATE: TELANGANA STATE: TELANGANA
PINCODE: 506112 PINCODE: 506112
MOBILE NO: 7093555329 EMAIL: naveenavula1998@gmail.com
SIGNATURE THUMB IMPRESSION

FEE AMOUNT TRANSACTION NO TRANSACTION DATE

NOT EXEMPTED 100 CPJ4155921 8/27/2018 12:00:00 AM
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.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 27/08/2018 6:23:10 PM