Application of Job: PC [10PLUS 2 BTECH (EDUCATION)],PC [10PLUS 2 BTECH (EXECUTIVE &

TECHNICAL)] - 07/2022

Application No: PCT227M000026 Application Date: 27/01/2022

PRIORITY

1. PC [10PLUS 2 BTECH (EXECUTIVE & TECHNICAL)] 07/2022

2. PC [10PLUS 2 BTECH (EDUCATION)] 07/2022

PERSONAL PARTICULARS

Name: SURJEET KUMAR

Father's/Mother's Name: SATYABHAN SINGH
Guardian's Name:
Nationality: INDIAN
Identification Mark 1: MOLE ON LEFT EAR
Identification Mark 2: MOLE ON LEFT CHEEK
Pancard: LJMPK7630Q
Date of Birth: 20/09/2003

EDUCATION PARTICULARS

Details of 12th Science

Subjects Total Marks Obtained Marks

English 100 85

Physics 100 81

Chemistry 100 85

Maths 100 59

Biology 100 79

Total Marks: 500 Marksheet Serial Number: 21609620

Obtained Marks: 389 State Conduct: UTTAR PRADESH
Percentage: 77.80 Board Conduct: Central Board of Secondary Education
(CBSE)

JEE Rank Detail

Year: 2021 All India Rank: 141921 Application Number: 210310679507

Details of 10th

Total Marks: 500 Marksheet Serial Number: 5324651

Obtained Marks: 467 State Conduct: UTTARAKHAND
Percentage: 93.40 Board Conduct: Central Board of Secondary Education
(CBSE)

MILITARY RECORD

Have you ever been enrolled in Armed

NO
Forces before?:
Have you attended any
Services Selection Board YES Service type: Army Type of entry: TES 46
(SSB) before?:
Have you been discharged
NO
from Armed forces before?:

COMMUNICATION PARTICULARS

Details of Permanent Address

Address 1: VILL NARAULI Address 2: PO KISRAULI, KASGANJ

State: UTTAR PRADESH District: ETAH Pincode: 207124
Phone No.: 7668094790 Mobile No.: 7668094790
ysurjeet148@gmail
Email id: yadavsurjeet007on@gmail.com Alternate Email id:
.com

Details of Correspondence Address

Same as Permanent Address

Alternate Mobile Number: ---------

A. I hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of Indian and
have never been debarred from appearing at any examination. I have never been arrested/ prosecuted and convicted by a
criminal court or involved in any other case registered by the Police.
B. I hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my
knowledge and belief.
C. I fully understand that in the event of my information being found false or incorrect, appropriate action can be taken
against me.
D. Eligibility criteria will be verified on reporting at the selection centres. I found ineligible, I understand that criminal
proceedings can be initiated against me for fraudulent entry and falsification of Government of Indian documents. I also
accept that no TA/ DA will be admissible to me in such cases.