Office Use Office Use Office Use Registration No

16033468489

1.Candidate Name AKASH VERMA 2.Parent Name RAJESH KUMAR 3.Nationality Indian

4.Date Of Birth 20-12-1997 5.Marital Status Un Married 6.Qualification Intermediate EPM

7.Intermediate/Voca 87 8.Name of Himachal Pradesh 9.Matric Board Himachal Pradesh

tional/Diploma Intermediate/vocatio Board of School Board of School
English % nal/Diploma Education Education

10.Matric Roll No 146935 11.Aggregate 85 12.Mobile No 7807035879

13.EMail Id akvermaa405@gm 14.SOAFP No 15.Discharged from No

ail.com Forces

16.Stream Applied Group-XY 17.Identification cut on forehead 18.Candidate Height 165.0cm

mark

19.Exam Center ASC-1 Ambala 20.Exam Center ASC-3 Kanpur 21.Exam Center ASC-15 Bhopal
Choice 1 Choice 2 Choice 3
22.Permanent ,DADOH,GALOR 23.Communication ,DADOH,GALOR 24.Preference for 1st preference: X
Address E,HAMIRPUR,Hi Address E,HAMIRPUR,Hi group XY candidate 2nd preference: Y
machal machal only
Pradesh,177026, Pradesh,177026,

25.Chest Size 12 Inch 26.Waist Size 30 Inch 27.Shoe Size 7 No.(Bata)

DECLARATION BY THE CANDIDATE
I hereby declare that all statements made in this application are correct.I understand that I am
liable to be disqualified at any stage, if the information given is found to be
incorrect/incomplete/false. I undertake to produce all original certificates and statement of marks
and three photocopies of each, duly attested by a Gazetted Officer, at the time of appearing in the
Paste your
Selection test. I am willing to undergo physical and medical test, at my own risk and will not be
entitled for compensation for injuries if any, sustained during such test. I am aware that the photograph
decision by President, CASB will be final and binding on me.

Signature of the candidate

Left Hand Thumb

Signature of parent/guardian impression
(If candiddate below 18 yrs on the day of filling application)
------------------------- 1 60334 68489 2

Name(Gaurdian if applicable ) :
Place:

Date:

-----------------------Tear off and Paste on Envelope------------------- -----------------------Tear off and Paste on Envelope-------------------

To, 16033468489
President Group-XY
Central Airmen Selection Board
PO Box: 11807
New Delhi-110010 1 60334 68489 2 85