Government of Maharashtra

STATE INSTITUTE FOR ADMINISTRATIVE CAREERS (SIAC)

Hazarimal Somani Marg, Opp. Chhatrapati Shivaji Terminus (CST), Mumbai - 400001. Application
Maharashtra.
NO.
Phone No. : 022-22070942,22061071, Website : www.siac.org.in 220004035

APPLICATION FORM FOR ENTRANCE EXAMINATION (SIAC-CET-2022)

1. Candidate Name :
    (As mentioned in SSC INGALE ASHWINI RAVINDRA
Marksheet)
First Name : ASHWINI

Father's Name / Middle Name : RAVINDRA

Surname : INGALE
Mother's Name : LALITA

2. Address for Communication 75 RAJGRUH FOREST COLONY Photograph and Signature

: NAGAO BARI

DEOPUR DHULE

City : DHULE Pin Code : 424005

District : DHULE State : MAHARASHTRA

STD Code : Tel. No. : 9284085490

Mobile Number : 9284085490 E-Mail : ashwini28ingale@gmail.com

3. Gender : FEMALE

4. Divyangjan : NO 5. Orphan : NO
6. Category : 02-SC

27
years
Age
7. Date of Birth : 28/07/1996 and
:
4
days
8. Domicile of Maharashtra : Yes

9. Optional Subject (Mains) : SOCIOLOGY

10. Examination Centres : PUNE
11. Disputed Maharashtra-
No
Karnataka Border :

12. Family Annual Income : Upto 150000

13. Do you belong to Minority 14. Type of

NO
Community : Admission :

14. Join any of these

NO
institutions for training before :

16. Year of
15. Educational Qualification : GRADUATE 2019
Passing :
YASHWANTRAO CHAVAN MARASHTRA OPEN UNIVERSITY,
17. University Name :
NASHIK
18. Opting Training Center: SELECT
Declaration :
I hereby declare that all statements made in this application are true, complete and
correct to the best of my knowledge and belief. In the event of any information being
found false or incorrect, or ineligible being detected before or after the examination,
action can be taken against me.