Application Registration No : 60001168865 for Combined Graduate Level Examination-2016

1.& 2. Examination Center and Code : KKR-Thiruvanthapuram(9211)

3. Candidate Name : NAIRAH R

4. Father's Name : M RAFI

5. Mother's Name : SHAHEEN HASSAN

6. Date of Birth(dd/mm/yyyy): 21/11/1991

7. Gender : Female

8. Nationality : Indian

9. Fee Exemption claimed : Exemption

10. Category : General

10.1. Whether Ex-Serviceman? : No

10.2. If, ExS, Whether seeking reservation? :

10.3. For Ex-Serviceman-Length of Service(in years) :

10.3. Date of discharge :

11. Whether PH : No

11.1. If yes, indicate code :

12. Whether seeking Age relaxation : No

12.1. If yes, indicate code :

12.2. Age(as on 01.01.2016) : 24.1

13. Preference for posts : CJKNBGEDLMAHO%SPRQIUTVWX@Z#Y$

14. Are you applying for the posts of Statistical Investigator Gr.II/ Compiler ? : Yes

14. Do you possess EQ for the posts of Statistical Investigator Grade II/ Yes
Compiler? :

14. Are you applying for the posts of AAO ? : No

14. Do you possess EQ for the posts of AAO ? : No

15. Whether you belong to Religious Minority Communities as per Govt. Yes
Orders ? :

16. If VH/ Cerebal Palsy candidate, whether scribe is required ? : No

16.1. If yes, indicate medium :

17. Aadhar Card Number : 973948998963

18. Qualification Details (Start from Graduation) :

Educational Qualification Subject Percentage(%)of Marks Medium

B.TECH Civil Engineering 63.60 English

19. Details of Work Experience/Govt. Service rendered :

Name of the Organisation(s) Designation Nature of Duty(ies) Period Of Service Period Of Service
From(mm/yyyy) To(mm/yyyy)

ARTECH REALOTORS PVT TRAINEE SITE SUPERVISION 06/2013 09/2013

LTD ESTIMATION BILLING

Contact Details Form :

20. Postal Address : KULANGARA BREEZELAND CHERUVAICKAL THURUVIKKAL P O
MEDICAL COLLEGE TRIVANDRUM

State : Kerala

Pincode : 695031

21. Permanent Address : KULANGARA VALIYAKADA CHIRAYINKEEZHU P O

State : Kerala

Pincode : 695304

STD Code : 0471

Phone Number : 2117234

Mobile Number : 8089638952

Email ID : nairahrafi.kulangara@gmail.com

PHOTOGRAPH AND SIGNATURE :

SCANNED PHOTOGRAPH OF THE CANDIDATE: SCANNED SIGNATURE OF THE CANDIDATE

DECLARATION:
I hereby declare that all the 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 false or incorrect at any stage or not satisfying the eligibility criteria according to the requirements of the relative
advertisement, my candidature/appointment is liable to be cancelled/terminated. I am willing to serve anywhere in India.

Place:

Date(yyyy-mm-dd) : 2016-03-17

Signature of Candidate