Northern Coalfields Limited

A mini ratna Company, An undertaking of Government of India

Head office: Panjreh Bhawan,Morwa,Singrauli-486889,M.P,India

Admit Card

Name ROHIT SRIVASTAVA Gender MALE DOB 15/09/1998

Father/Husband's Name SANTOSH SRIVASTAVA Category(Vertical) GEN Category(Horizontal) N/A

PwBD NO Disability Type N/A Subscribe Required No

C 32/31 A-5, CHANDUA CHHITTUPUR VARANASI P.O:CANTT,VARANASI,UTTAR PRADESH
Address
PIN-221002
Post Applied OVERSEER GR C Post Code 9

Roll No. 41903939 Mobile 8542801898

Affix the same self

attested
photograph

Name and address of the Examination Venue Schedule of the Exam.

Padmasini Vidya Vihar Inter College, Bhoolanpur, GT Road Varanasi, Uttar Report at 01:00 PM to 03:00 PM

Pradesh 221108 27 Dec 2020 (Sunday)

Schedule of Test: 03:00 PM - 04: 30 PM

27 Dec 2020 (Sunday)

(Signature of Issuing Authority)

(Signature of Candidate in Examination Centre) (Signature of Invigilator)

Self Declaration (Undertaking) regarding COVID-19
1. That, I have read the Instructions, Guidelines and relevant orders pertaining to COVID-19 pandemic. I have read Information Bulletin, Instructions and Notices
related to this examination available on the website 'https://nclcil.in/'. I/we have read the detailed 'IMPORTANT INSTRUCTIONS for CANDIDATES' and I/ we
undertake to abide by the same.
2. I have in the last 14 days(please tick , wherever it is applicable to you, otherwise leave blank): The following flu-like symptoms:
Fever: Cough: Breathlessness: Body ache: Runny Nose/Sore Throat:
Others- Please specify:
a)Been in close contact with a confirmed case of the COVID-19. ('Close contact' means being at less than one meter for more than 15 minutes.)
b)Not been in close contact with a person suffering from COVID-19 and am NOT under mandatory quarantine.
c)Travelled the following cities/ country in 'the last 14 days prior to arriving at the Centre.
1st City 2nd City 3rd City 4th City
Name of cities/country
Date of arrival in Center city
3.The health and wellbeing of our community is our first priority; therefore the centre reserves the right to deny entry to its premises.

Candidate's Signature

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