QOFSS VARARAST CH NO (PH. DECLARATION FORM CH NO (PHA): (Next of Kin (Name) [pusuen Savitn | Relation: moraca, | ContactNor RADE BEUSSS 1 DIRECT PH —i1 =¥ESINO POST aTioel oul S SCH/ MIL SCH/ RIMC/ AFPU SPI (Tick) ARMED FORCES! GOVT/ PSU EMP =YESINO — (IF YES, NOC) =¥ESINO i AAUPSEIAFCAT NO |o409403.612 | 2 BATCHNO 3.DATEOFBIRTH |, , ‘4. NAME (as in 10" (DDIMMIYYYY) pass certificate) | TTTENDAA SINGH | (elGeuonPerteuce eee 8. Are you a habitual wearer of Glasses niPost Graduation’ 6. Total % of marks "2BAG/. 7. Current Backlog -¥E6iNO | / SPectacles or Contact Lens? FOR S/OUT & REPEATERS ONLY 9.Have you appeared earlier in SSB for ARMY/ NAVY! AIR FORCE/ COAST GUARD? ~—-YES/N@— Ifyes, give following details (Note: write overieaf if space is inadequate): ‘SINO ‘Type of Entry viz Result No. of days Previous Batch | Place & Date AFCATINGCINDAICDSIcG/ | Siout | NO. of day & Chest No, (Mandatory) UESITES/10+2 TESISECIMET | NotRec | See¥ea ot (Mandatory) Rec 7 GARATINISSt [CARORENRGRE | AFERT Mer ace | OS & 04 42\ 642034, 2 [| BALLU esse) [RAPORTRALA EL SSt Ure - Se ‘S\ouT o1 & SB An\os\aca4 J [AOSeuaesss) BAoPAL Re SSC ten) -SS Sloot OL Ad AR\09\ 2020 9 10 10. Have you appeared for INSB/PABICPSS Test earlier?—¥ESINO If yes, give following details: Batch No. | ChestNo.| _AFSB Centre Date CPSSIPAB Result (Put tick) PASSIFAIL, 11. Thereby declare that the statement made in this form is true to the best of my knowledge and belief. In case of any incorrect information, my candidature is liable to be cancelled. | also understand that the decision of the IAF on lity condition would be final. | have no relatives or known person working in this Selection Board. Date:40|04\22 Sign of candidate: Se Mob No, : 4500503504