Application of Job: AGNIVEER [SSR-F] - 01/2022

Application No: SSRF22104007971N Application Date: 18/07/2022

PRIORITY

1. AGNIVEER [SSR-F] 01/2022

PERSONAL PARTICULARS

Name: KHUSHI KUMARI

Father's/Mother's Name: SANJAY SINGH
Guardian's Name:
Nationality: INDIAN
A CUT MARK ABOVE EYE
Identification Mark 1:
BROW
Identification Mark 2: A MOLE MARK ON NECK
Date of Birth: 04/02/2003
Aadhaar Number:
8181
(Last 4 digit)
PAN Number: ---------
Voter ID Number: ---------
Passport Number: ---------
Ration Card Number: ---------

EDUCATION PARTICULARS

Details of 12th Science

Subjects Total Marks Obtained Marks

Physics 100 60

Chemistry 100 48

Maths 100 47

Total Marks: 300 Marksheet Serial Number: 1221662697

Obtained Marks: 155 State Conduct: BIHAR
Percentage: 51.67 Board Conduct: Bihar School Examination Board

Details of 10th

Total Marks: 500 Marksheet Serial Number: 710055072

Obtained Marks: 322 State Conduct: BIHAR
Percentage: 64.40 Board Conduct: Bihar School Examination Board
 MILITARY RECORD

Have you ever been enrolled in

NO
Armed Forces before?:
Have you been
discharged from
NO
Armed forces
before?:

COMMUNICATION PARTICULARS

Details of Permanent Address

Address 1: CHAINPUR Address 2: PO-SHAHAR TELPA,PS-TELPA

State: BIHAR District: ARWAL Pincode: 804419
Domicile: BIHAR Phone No.: 9835823645 Mobile No.: 9835823645
HARENDRAKUMAR10102005@GM
Email id: Alternate Email id: ---------
AIL.COM

Details of Correspondence Address

Same as Permanent Address

Alternate Mobile Number: ---------

A. I hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and
have never been debarred from appearing at any examination. I have never been arrested/ prosecuted and convicted by a
criminal court or involved in any other case registered by the Police.
B. I hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my
knowledge and belief.
C. I fully understand that in the event of my information being found false or incorrect, appropriate action can be taken
against me.
D. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal
proceedings can be initiated against me for fraudulent entry and falsification of Government of India documents. I also
accept that no TA/ DA will be admissible to me in such cases.