STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
CONSTABLE (DRIVER) - MALE IN DELHI POLICE
EXAMINATION, 2022

REGISTRATION NO: 74000560100

APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFICATE NAME
ADITYANARAYANA BARIK - RAMAKRUSHNA BARIK MAMATA BARIK
5. DATE OF BIRTH
6. AGE AS ON 01/07/2022 7. GENDER 8. CATEGORY
(DD/MM/YYYY)
25/06/1997 25 MALE OBC
9. WHETHER PERSON WITH DISABILITY (PwD)? 9.1 IF YES, TYPE OF DISABILITY
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA ONE BLACK MOLE ON RIGHT COLLAR BONE
14. MATRICULATION
13. MATRICULATION
12. MATRICULATION (10th CLASS) EXAMINATION BOARD (10th CLASS) YEAR OF
(10th CLASS) ROLL NO
PASSING
BOARD OF SECONDARY EDUCATION, ODISHA BAM012002 2012
15. WHETHER DEPARTMENTAL CANDIDATE OF DELHI POLICE ?
NO
16. WHETHER SON OF SERVING, RETIRED OR DECEASED PERSONNEL/ MULTI-TASKING STAFF OF DELHI POLICE
NO
17. HAVE YOU REPRESENTED A STATE AT THE NATIONAL LEVEL OR THE 17.1. IF YES, DISCIPLINE OF YOUR
COUNTRY AT THE INTERNATIONAL LEVEL IN SPORTS DURING PRECEEDING 3 SPORT
YEARS FROM THE CLOSING DATE OF RECEIPT OF ONLINE APPLICATIONS?
NO -
18. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
BHUBANESHWAR ( 4604 ) CUTTACK ( 4605 ) DHENKENAL ( 4611 )
19.1. WHETHER YOU ARE AN EX- 19.2. DATE OF JOINING THE ARMED 19.3.DATE OF DISCHARGE/ LIKELY
SERVICEMAN (ESM) OR SERVING IN FORCES (DD/MM/YYYY) DATE OF DISCHARGE FROM ARMED
THE ARMED FORCES? FORCES (DD/MM/ YYYY)

NO - -

19.5. HAVE YOU ALREADY JOINED A

19.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT OF 19.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES RESERVATION FOR EX-SERVICEMAN (DD/MM/YYYY)
(ESM) ?

- - -
 20.1. WHETHER SEEKING AGE 20.2. IF YES,INDICATE CODE
RELAXATION ?
YES 02-OBC
21.1. ARE YOU A NATIONAL CADET CORPS (NCC)
21.2. TYPE OF THE NCC CERTIFICATE
CERTIFICATE HOLDER ?
YES NCC "A" CERTIFICATE
22.1. DO YOU POSSESS DEGREE/ POST GRADUATE
22.2. IF YES, CLASS OBTAINED IN DEGREE/ POST
DIPLOMA AWARDED BY RASHTRIYA RAKSHA UNIVERSITY
GRADUATE DIPLOMA:
(RRU)?
NO -
23. HIGHEST EDUCATIONAL QUALIFICATION
BA (5)
24. DETAILS OF QUALIFYING EDUCATION
12TH STANDARD
STATE/ UT OF
NAME OF BOARD/ PERCENT
STATUS PASSING YEAR BOARD/ ROLL NO CGPA
UNIVERSITY AGE
UNIVERSITY
COUNCIL OF
HIGHER
PASSED 2015 ODISHA SECONDARY 408MC009 35 -
EDUCATION,
ODISHA
25. DO YOU POSSESS A VALID HEAVY MOTOR DRIVING
25.1. DRIVING LICENSE NO
LICENSE?
YES OD02K20160103981
25.2. NAME OF ISSUING AUTHORITY 25.3 DATE OF ISSUE
ARTO KHORDHA 25/02/2016
ADDRESS DETAILS
26. POSTAL ADDRESS 27. PERMANENT ADDRESS
AT-HATA DELANG PO-DELANG AT-HATA DELANG PO-DELANG

DISTRICT: PURI DISTRICT:PURI

STATE: ODISHA STATE: ODISHA
PIN : 752015 PIN : 752015
MOBILE NO: 8658225158 EMAIL: barikaditya75@gmail.com
28. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 08-APRIL-2022?

YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 CPABVSGNS7 12/07/2022
 DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE
NOTICE OF THE EXAMINATION.

2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF ANY
INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE CANCELLED.

3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.
PRINT TAKEN ON: 02/08/2022 10:42:01 AM IP ADDRESS: 157.41.133.32
NUMBER OF ATTEMPT: 1