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NATIONAL DEFENCE 4 : ACADEMY
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ONLINE APPLICATION FORM 20 : Lower Division Clerk
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Application No : 222/ DC/
5 41UR/ 00254109
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Post Applied For : Lower / 00 Division Clerk
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Applied Caste / Class Type 2 : UR 2 0 6.2
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Category V : UR -1 0
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Name : SHRAWAN
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T URShraw an Shivkum ar M other's Name : NEELAM CHATURVEDI
Name (M atric.) A
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AN Religion : HINDU
Father's R AW Name
Full : SHIVKUM AR CHATURVEDI
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DOB : 14 - MAY - 2001 Caste Type : 0 UR . 2 1 0.20
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Phone No (STD Code) : 09284510873 Caste 7 : 4 0 PM : Brahmin
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State/ UT of Origin : MAHARASHTRA 5 4 1 09-0
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Correspondence : 105, GAJ ANAN GALLI NO 1, Permanent - 10
Address : 4105, GAJANAN GALLI NO 1,
Address BEHIND ADN ho spit al, P M
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Bhaw ani Nagar, Pardi, Nagpur : 27 6 . 2 Nagar, Pardi,
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Sr. No. Document Type Document No 2 7: Document Name
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1. Pho t o 30 IM G_20221213_191221_326.jpg
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2. Signat ure a n- gf c .jpg
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Declaration - 22 M-1
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• I hereby confirm that R I have read the “General Instructions” provided 04 at home page.
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• I accept allNtheCHrules & regulations and eligibility criteria -Ja against each post given in the “General Instructions”
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provided
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Wat the home page in https:// ndacivrect.gov.in5 4 109
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• I hereby declare that the information C provided by me in this online application form is true, complete and
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correct to the best of my D I-
knowledge and belief. I understand that in the event of any information being found
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false or incorrect atTUanyRV stage, my candidature/ appointment is liable to be cancelled/ terminated.
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Place: Nagpur Date: 06 - JAN - 2023
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