7/3/22, 8:03 PM Application Form Preview

APPLICATION FORM FOR MALE CANDIDATES

FOR SELECTION IN INDIAN AIR FORCE AS
AGNIVEERVAYU SCIENCE SUBJECTS: INTAKE 01/2022

Payment Status: Online Payment Success Registration No. 22060856524 Gender: Male

Candidate Name Piyush Kumar Parent Name Shiv Shankar Nationality Indian
Kumar

Date of Birth 02-05-2001 Marital Status UnMarried Qualification 12th

Aggregate % 66 Is Qualification Yes Name of Bihar School

with Education Board Examination
Physics/Math Board

English % 65 Maths % 64 Physics % 68

Additional No
Marksheet

Mobile No. +919525226408 Email Id sawanforu822 Aadhaar Card 561588189149

@gmail.com No.

Serving IAF No NCC Certificate No SOAFP No

NC(E) Holder

Discharged from No Stream Applied Science Identification Burn mark on

Forces/Govt. Subjects Mark right leg
Organization
Candidate Height 160 cm

Exam City Patna Chapra Bhagalpur Gaya Muzaffarpur

preferences for
phase
I

ASC preferences 10 ASC, Bihta 3 ASC, Kanpur 1 ASC, Ambala 5 ASC, Jodhpur 7 ASC,
for phase II Bengaluru

11 ASC, 12 ASC,
Guwahati Secunderabad

Permanent pura Communication 4m/135 ma jagdamba store

Address bhar,datiyana,bikram,Patna,Bihar,8 Address bhoothnath,patna,patna
01104 sadar,Patna,Bihar,800026

Chest Size 34 Inch Waist Size 30  Inch Shoe Size 7  No.

DECLARATION BY THE CANDIDATE Paste

I have
read and understood all the instructions for filling this
application form. Further, I declare that
statements made in
this application are correct. I understand that I am liable
to be disqualified at your
any stage, if the information given is
found to be incorrect/incomplete/false. I will produce all
original certificates and statement of marks and three
photocopies of each, duly attested by me, at
Photo
the time of
appearing in the phase II. 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 decision by President, CASB will be
final and binding on me.

Thumb
Impression
Signature of the
candidate

Place:Patna

Date:03-07-2022

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