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NATIONAL DEFENCE 10 ACADEMY
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ONLINE APPLICATION FORM 6 : Lower Division Clerk
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Application No : 222/ DC/-2UR/ 02 00105181
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Post Applied For : Lower 2 -J Division Clerk 90
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Gender : 18Male 21 9
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Applied Caste / Class Type
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Category
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Nationality 22 : Indian 02
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Personal Details 222
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Name
A INA : M AINAK DEY
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Name (M atric.) : M AINAK DEY M other's Name.219.45. :
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Father's Full Name : GOUTAM DEY Religion
6 : 2 6 PM : HINDU
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DOB : 18 - MAR - 1998 n-20 Identification M ark : No M ark
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Phone No (STD Code) : 105 Caste Type : UR
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M arital Status 22: /D Single Caste :
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ofAOrigin
State/MUTAIN : WEST BENGAL
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Address Details . 2 19
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Correspondence : M IRAPOTA BUJ RUKDIGHI P Permanent Address : MIRAPOTA BUJRUKDIGHI
Address : 26
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State/ UT : WEST BENGAL 0 8:
3 District : PURBA BARDHAM AN
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District : PURBA BARDHAM - 9 0
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: BUJRUKDIGHI
PO : BUJRUKDIGHI 2 -J . 4
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Pin : 71342305 0
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Educational & Additional
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Sr. E Y- 2 02 M arks /
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No K Roll No.
School/ College
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10 West
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1 12t h /D .42015 500 Yes A 74.80
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2 22 C.K. INSTITUTION BENGAL Higher.219
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Experience Certificate .45
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10 Govt/ Privat Recognised Exp./ Cert. Exp./ Cert.
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1. A Pho t o 1 IM G_20220419_094458.jpg
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2. Signat ure 0 IM G_20220419_110544.jpg
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Declaration
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• I hereby confirm that I have read the “General Instructions” provided at1home
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• I accept all the rules & regulations and eligibility criteria 08:5against each post given in the “General Instructions”
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provided at the home page in https:// ndacivrect.gov.in 2-Ja
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• I hereby declare that2/the C information provided by me in this online application form is true, complete and
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correct toKtheD best of my knowledge and belief. I understand
INA 3.2 that in the event of any information being found
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false incorrect at any stage, my candidature/ appointment - 10 is liable to be cancelled/ terminated.
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Place: MIRAPOTA n -2 Date: 0290- JAN - 2023
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