उत्तर प्रदेश सरकार GOVERNMENT O F UT T AR PRADESH

उत्तर प्रदेश अधीनस्थ सेवा चयन आयोग

Uttar Pradesh
Subordinat e Services Select ion Commission

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Ut t ar Pradesh Subordinat e Services Select ion Commission,Lucknow

उत्तर प्रदेश अधीनस्थ सेवा चयन आयोग, लखनऊ

✔ I Declare that i have Read the detailed User Manual & Notifi cation.

Notification Details :

Advt Number : 04-Exam/2022

Applied Fo r : PRELIMINARY ELIGIBILIT Y T EST (PET ) 2022,

Personal Details

Regist rat io n Number.

30234562379 Advert isement / No t ificat io n No 04-Exam/2
Candidat e Name MOHD FAISAL Fat her's / Husband's Name MOHD SHAMEE

Mo t her's Name RESHAMA BEGAM Dat e Of Birt h 02/07/2003

Do micile Of UP Yes Ho me St at e UT TAR PRADES

Ho me Dist rict SHAMBHAL Gender Male

Cat ego ry OBC Eco no mically Weaker Sect io ns(EWS) No

Are yo u Married ? No Mo bile Number 81* * * *6419

Email ID * * *41568@ gmail.co m

Candidate's Other Details

Are Yo u Dependent o f UP Freedo m Fight er? No Are Yo u UP Ex. Army?

Are Yo u ECO/SSCO/CO Of Army No

Are Yo u Skilled Player Of UP? No Level o f Player N/A

Employment Det ails Never Employment in Ut t ar Pradesh

Are Yo u Handicap o f UP? No

Are yo u Blind Or Have Visio n pro blem? No

Are yo u Deaf o r Have hearing pro blem? No

Have yo u any physical Pro blem? No  

Have yo u psycho lo gical/ neuro lo gical pro blem? : No Have yo u Mult iple Disabilit ies? : No

Additional age relaxation other than above reasons(Caste category,Sub category,Service duration etc.)

Are you c la iming a ny a ddit iona l a ge rela xa t ion ? No

Academic Qualification

Examinat io n
Bo ard Name Year o f Passing Ro ll
Is Grade
Obt a
Passed Number Syst em Mark

High Scho o l UT TAR PRADESH BOARD OF HIGH SCHOOL AND INT ERMEDIAT E EDUCAT ION 2019 0762804 Yes N/A

Int ermediat e UT TAR PRADESH BOARD OF HIGH SCHOOL AND INT ERMEDIAT E EDUCAT ION 2021 215647371 Yes N/A

Preferential Qualification Details

 S No. Qualificat ion

1 Served in t he Territ o rial Army f o r a minimum perio d o f 02 years.

2 Has been o bt ained Nat io nal Cadet Co rps B cert ificat e.

Bank Transaction Details

Bank Name - Payment Mo de : St at e Bank Of India - Fees, Transact io n ID - Dat e: Rs. 185.00 , C

↓ Address Details ↓ Permanent Address Correspondence/Mailing Address

Name , C/O: Mo hd Shameem Mo hd Shameem

Ho use no ./Village : Village janet a Village janet a

St reet No ./PO : Sambhal Ro ad Sambhal Ro ad

Lo calit y/Kasba/Cit y : Chandausi Chandausi

St at e / Dist rict Name : UT TAR PRADESH

/
SHAMBHAL UT TAR PRADESH
/
SHAMBHAL

Pin : 244412 244412

Declaration

1. I hereby declare t hat I have read all t erms & condit ions according advert isement and I accept it .

2. I hereby declare t hat all t he ent ries/st at ement s made in t his applicat ion are t rue, complet e and correct to t he best of my knowledge and belief.

3. In t he event of any informat ion being found false or incorrect or ineligibilit y being det ect before or aft er Select ion, t he commission can t ake act ion against me as p
have misled UPSSSC on any issue t hen I will solely be responsible for all penal consequences t hereof.
I accept t he above declarat io n :
Yes
Current st at us of applicat ion

Your applicat ion is under processing.

App. form submission date :
 
DATE :25/07/2022 ,TIME :19:11:24
   App. form printing

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