16/12/2021, 23:27 :: ONLINE APPLICATION ::

INDIAN COAST GUARD

ONLINE APPLICATION FORM
Application No. : 222/145442
  Roll No. :  

(1) Name of the post applied for :

Asst. Commandant General Duty Affix recent
passport size
(2) colour Photo
Centre at which you wish to appear for Test  :  

Date and Time of  Reporting at Centre :

Centre
Priority Full Address of the Centre
Name
  INDIAN COAST GUARD, DIRECTORATE OF RECRUITMENT, C-
NOIDA
1 1, NEAR INDUS VALLEY PUBLIC SCHOOL, SECTOR-62, NOIDA,
- NO
UTTAR PRADESH, PIN-201301

(3) Name of the candidate (as in Matriculation) :

  ATUL BISHT
 Gender :
Male
(4) Current postal address :
VIKAS NAGAR GARIGHAT, CITY: KOTDWARA, STATE: UTTARAKHAND, DISTRICT :
 
PAURI GARHWAL, PIN : 246149
(5) Permanent address :(The State of Permanent address has to be same as domicile certificate)
VIKAS NAGAR GARIGHAT, CITY: KOTDWARA, STATE: UTTARAKHAND, DISTRICT :
 
PAURI GARHWAL, PIN : 246149
(6) E-mail ID :   
at*************.com
     Mobile No :
  
+9*****592
(7) Mother's name :
SARIKA BISHT
(8) Father's name :
DEVENDRA SINGH BISHT
(9) Category :
General
 (10) Date of Birth :
27 Jan 2000
  (11) Nationality :
Indian
(12) Qualification :
Compl. Compl. Year of
Qualification Board/Institution AggrPercent
Subject Mark Passing
12th CBSE 74.6 Physics 73 2017
        Maths 64 2017
HEMWATI NANDAN
Graduation(B.Sc) BAHUGUNA GARHWAL 66.37 --NA-- 0 2020
UNIVERSITY
(13) Knowledge of Swimming :
NO
(14) Proficiency in sports, National Level (attach photocopies of certificate) :
NO
(15) NCC certificate obtained (attach photocopy of certificate, if yes) :
--NA--
(16) Marital Status :
Unmarried
(17) Is Wards of Coast Guard deceased/Service Personnel :
NO
(18) Is your father serving /retired from Defence : NO
(19) Is Service Personnel : NO
(20) Is EWS(Economically Weeker Sections) : NO
https://joinindiancoastguard.gov.in/Report.aspx?gnZBcj5ZUung1TE9Go3MHGinGcF45IMyNKBhbzYk0hg= 1/2
16/12/2021, 23:27 :: ONLINE APPLICATION ::

(21) Declaration :
I, hearby solemnly declare that all the statements made in the above application are true and correct to the
  best of my knowledge and belief. I fully understand that in the event of any information being found false
or incorrect, my candidature will be cancelled.
Place : DEHRADUN Signature :
Name of the Applicant :
ATUL
Date : 16/12/2021
BISHT
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