Application of Job: AGNIVEER [SSR-M] - 01/2022

Application No: SSRM22112364104N Application Date: 24/07/2022

PRIORITY

1. AGNIVEER [SSR-M] 01/2022

PERSONAL PARTICULARS

Name: ABHISHEK PRATAP SINGH

Father's/Mother's Name: LATE SANDESH KUMAR
Guardian's Name: DHEERESH KUMAR
Nationality: INDIAN
Identification Mark 1: BIRTH MARK ON LEFT THIGH
Identification Mark 2: MOLE NEAR STOMACH
Date of Birth: 21/03/2003
Aadhaar Number:
5558
(Last 4 digit)
PAN Number: ---------
Voter ID Number: ---------
Passport Number: ---------
Ration Card Number: ---------

EDUCATION PARTICULARS

Details of 12th Science

Subjects Total Marks Obtained Marks

Physics 100 70

Chemistry 100 68

Maths 100 67

Total Marks: 300 Marksheet Serial Number: 0624103

Obtained Marks: 205 State Conduct: MADHYA PRADESH
Percentage: 68.33 Board Conduct: Central Board of Secondary Education (CBSE)

Details of 10th

Total Marks: 500 Marksheet Serial Number: 0331722

Obtained Marks: 422 State Conduct: MADHYA PRADESH
Percentage: 84.40 Board Conduct: Central Board of Secondary Education (CBSE)

MILITARY RECORD
Have you ever been enrolled in
NO
Armed Forces before?:
Have you been
discharged from
NO
Armed forces
before?:

COMMUNICATION PARTICULARS

Details of Permanent Address

H.NO. 20 GYAN GANGA INTERNATIONAL

Address 1: Address 2: HOSHANGABAD ROAD, MISROD, BHOPAL
ACADEMY CAMPUS
State: MADHYA PRADESH District: BHOPAL Pincode: 462026
Domicile: MADHYA PRADESH Phone No.: 6260387987 Mobile No.: 6260387987
bablusingh1972.bs@g
Email id: abhishekpratapsinghx21@gmail.com Alternate Email id:
mail.com

Details of Correspondence Address

Same as Permanent Address

Alternate Mobile Number: 9548343423

A. I hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India 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. If found ineligible, I understand that criminal
proceedings can be initiated against me for fraudulent entry and falsification of Government of India documents. I also
accept that no TA/ DA will be admissible to me in such cases.