Registration Date:23-01-2018 02:23 PM Print Date:23-01-2018 02:41 PM

INDIAN ARMY
Directorate General of Recruiting
SSCW(Tech)-22/751679

MY
AR
Personal Details
AN
1. Roll No SSCW(Tech)-22/751679
2 Course Applied For : SSCW(Tech)-22
DI

3. Candidate's Name (As per Matric V SUSHMITHA

Certificate)
4. Father/Guardian Name P VEERARAGAVAN
IN

5. Mother's Name S NATTARKANI

6. Date of Birth (As per Matric Certificate) 10-05-1995
7. Nationality INDIAN
IN

8. If Other Nationality
9. Marital Status Unmarried
JO

10. Gender Female

11. Mobile No 9445357949
12. Email Address nattarkani15@gmail.com
13. Aadhar XXXXXXXX7632
14. Permanent Address Correspondence Address
Address 4/115 C AMMAN Address 4/115 C AMMAN
KOVIL STREET KOVIL STREET
UMARIKADU UMARIKADU
City / Town / Village UMARIKADU City / Town / Village UMARIKADU
State Tamil Nadu State Tamil Nadu
District Thoothukudi District Thoothukudi
PIN 628151 PIN 628151
15 SSB Details
(a) Entry (b) Location (c) Year/Month (d) Result
16 Education Details
(a) Type of School OTHERS
Registration Date:23-01-2018 02:23 PM Print Date:23-01-2018 02:41 PM

INDIAN ARMY
Directorate General of Recruiting
SSCW(Tech)-22/751679

(b) Roll No of 10+2 Examination OR Diploma 082043

(c) Whether Done Diploma No
(d) Aggregate % of Marks Obtained in Class 92.00
XII
(e) Engineering Stream Applied For Electronics &
Telecommunication/Telecommunication/Ele

MY
ctronics & Communication/ Satellite
Communication
(f) Specified Stream Electronics & Communication Engineering

AR
(g) Date Of Joining Engineering Course 28-08-2013
(h) Date of Completion of Engineering 18-04-2017
(i) Name of College/Institute UNIVERSITY VOC COLLEGE TUTICORIN
AN
(j) Name of University ANNA UNIVERSITY
(k) Type of University State University
DI

(l) State in which University Located Tamil Nadu

18. Marks/Grades obtained in Graduation
IN

Semester / Year Total Marks Marks Scored % of Marks Cumulative % of

Marks scored
Semester 1 100.00 82.69 82.69 82.69
IN

Semester 2 / 100.00 82.50 82.50 82.60

Year 1
Semester 3 100.00 75.00 75.00 80.06
JO

Semester 4 / 100.00 82.69 82.69 80.72

Year 2
Semester 5 100.00 81.74 81.74 80.92
Semester 6 / 100.00 75.83 75.83 80.08
Year 3
Semester 7 100.00 78.64 78.64 79.87
Semester 8 / 100.00 85.00 85.00 80.51
Year 4
Note
The universities which have ‘Grade Point’ system, need to convert Grades into %age of
marks; failing which the application will be rejected.
19. Certificates attached with application form:-
(a)
(b)
(c)
(d)
Declaration
Registration Date:23-01-2018 02:23 PM Print Date:23-01-2018 02:41 PM

INDIAN ARMY
Directorate General of Recruiting
SSCW(Tech)-22/751679

1. I have read and understood the instructions and undertake to abide by them.
2. I hereby declare that all statements made in the application are correct and true.
3. I undertake not to have any objections in the event of my final selection on allotment of
any Arms/Service in the interest of the organisation.
4. I have never been debarred from appearing in any examination or UPSC and nor have I
been arrested or convicted by a criminal court or involved in any other case registered

MY
by Police.
5. I undertake not to make any claim or compensation if at any stage of selection, my

AR
ineligibility is detected and my candidature is cancelled as a result thereof.
6. This is the only application submitted for SSCW(Tech)-22 and any duplicate application
if detected at any stage, my candidature be cancelled.
7. Any misinterpretation and wrong declaration] concealment of information in the
AN
application will render my candidature to be cancelled and I may be debarred from this
course.
8. I have never been withdrawn from NDA, IMA or OTA or any service training academy on
DI

disciplinary grounds.
9. I am employed with ____________________ & I have informed my employer in writing
IN

that I am applying for commission in the Army.

10. In the eventuality of being recommended by SSB I will have no objection to be medically
examined by board of Male/Female doctors, provided a lady medical officer is present
(applicable only to lady cadets).
IN

11. I undertake to be debarred & my candidature be cancelled, if at any stage of selection I

indulge in any violation of local orders concerning discipline aspects.
JO

12. I undertake not to marry till I complete the full training at the training academy, in case
inducted. I also understand that in case of my final selection, my appointment will be
provisional subject to satisfactory police and educational verification.
13. In case of resignation from Academy, cost of training will be paid by me.
14. This application is accepted provisionally subject to meeting eligibility criteria.
Declaration :
1. I affirm that all information supplied by me as above is true and correct, and I agree
that no change in particulars once filled by me will be permitted, I also fully understand that if
at any stage, it is discovered that any attempt has been made by me to wilfully conceal or
misrepresent the facts, my candidature may be summarily rejected or employment terminated.
2. I have read the notification for this entry and I agree to abide by all terms and
conditions as specified there in.
Place:
Date:23-01-2018 02:33 PM
Registration Date:23-01-2018 02:23 PM Print Date:23-01-2018 02:41 PM

INDIAN ARMY
Directorate General of Recruiting
SSCW(Tech)-22/751679

Signature of Applicant

Note

MY
1. After applying online, candidates are requested to take a print out, paste her attested
photograph in the space provided, sign it in blue ink in the space provided and carry the
application without fail along with the original certificates the certificate from the college

AR
principal regarding conversion of cumulative grade in %age of marks and with a valid
proof of identity to the Selection Centre when called for the interview. If candidate does
not carry the above said documents to the Selection Centre for interview, her
candidature will be cancelled.(No need to send printout of application to Recruiting
AN
Directorate).
(a) 2 sets of photocopy of DOB/Matriculation Certificate.
(b) 2 sets of photocopy of Education Qualification Certificate/Marksheets.
DI

(c) 2 sets of photocopy of the valid ID proof.

(d) 20 copies of self attested PP size photograph will also be carried alongwith
IN

the application form.

2. It may be noted that depending upon the total number of applications received by this
office,(Recruiting Directorate reserves the right to short list and to fix cut off
percentage of marks for SSB interview). No representation will be entertained in this
IN

aspect.
3. It may be Noted that candidates must apply strictly as per the notify stream of
Engineering as per Para 3 of Notification and equivalent stream are not allowed /
JO

permitted .
4. Any wrong details filled in above application will lead to cancellation of the candidature
and suitable action will be taken against the Candidate.
5. Submission of multiple applications for SSCW(Tech)-22 will lead to cancellation of
candidature.
CERTIFICATE BY PRINCIPAL/HEAD OF THE TECHNICAL INSTITUTIONS TO BE
SUBMITTED BY FINAL YEAR/SEMESTER CANDIDATES
Certified that Shri _________________________________ S/o _______________ Date of
Birth _________________ is studying in final year/final semester of B.E/B.Tech
_______________________ (Branch of Engineering) in this University/College/lnstitute and
her final year/semester examinations will be over by _______________________(Date) .

Place:______________ Signature:______________
Date: _______________ Designation:______________
Registration Date:23-01-2018 02:23 PM Print Date:23-01-2018 02:41 PM

INDIAN ARMY
Directorate General of Recruiting
SSCW(Tech)-22/751679

Note: Certificate signed by Heads of Departments will not be acceptable.

MY
AR
AN
DI
IN
IN
JO