1 903231 30209+0530

ARE YOU AN EX-SERVICEWOMEN OR NO

PRESENTLY SERVING (GOING TO RETIRE
wlTHlN oNE YEAR)? /$oll[I
G06ul6uln6h
grlnglo$$leurrJn etebeug gpGungl
uoollu-Ileu reiraflin? ( u6ufl unat q5bgt
grTnniurr4pget erTlQefl 6auu@ueln)

/6fi'ld'6il NO
ARE YOU A DESTITUTE WIDOW ?

sJgry 6,JD:D 6151

96D6x uJ n ?

sPEclAL rilaRxs lEpuq m$luCluaiotoeh

ARE YOU POSSESSING NCC A/B/C NO

cERTIFIcATES ? I $olln G96lu-t ur6uul6un
uoouuJlem At B I coneurflg$ocoen
eoo$gehafin I

ARE YOU POSSESSING NSS CERTIFICATES ? / NO

Serllir pnL-$ peu uuodlg$luL-9615u

anc'oflgp eoeu$generfi n z

NO
WOULD YOU LIKE TO AVAIL SPECIAL MARKS
FOR sPoRTS? / 6rtlm6nulILl+Dd,116[r

E gluq Lo$luGluaiuaeoenu CluP

eill6Loqdlfqnt

DOCUMENTS / €bolCImnu oeit

CONFIRMED
coMMUNITY CERTIFICATE / an$ooneurflgp ccRosE JPG
CONFIRMED
lOTH / SSLC CERTIFICATE/ 1oTH / SSLC aneoflggl RoSELIN JPG
CONFIRMED
psrM CERTIFICATE / q]fig urnDg GLon$lu5leu rc JPG

urqgggDon6no eneuflgp

DECLARATION: CORRECT AND COMPLETE TO THE

FURNISHED BY ME IN THIS APPLICATION ARE TRUE'
I HEREBY DECLARE THAT ALL THE PARTICULARS BEING FOUND FALSE OR INCORRECT OR INELIGIBILITY BEING
BEST OF MY KNOWLEDGE EriO SiLrri. IN THE
Or Er'rVir'TTONI.1ATION
EVENT
My cANDTDATURE wrLL BE cANcELaED. / gl6ila!6iifl6oriuug$leil el6fl9gl6il6n rnat
DETECTED BEF,RE oR AFTER-THaEXAMTNATToN,
orfluneng Loppll-o (!0(S5oL0uno,6rgi 616ur9' oslr afleUtiitO ApflpS
e{d.o6nggi olleurTnroqgLo e-ounrouulncug,
gulua$ Cf9nen956cf'n'i'aCp* GLogLh pneur eleifl$genen eflelrTri'raei Clunululncugl
eucos,u.Jleu 9co'lcotou-11-co etcutglcouu-t
ereur G9ner16g goareoGrJn, rJlrureurGryn aaiuL-flu-ruuulnstr
s{6b5ug gCupnsrrg al6u6ugl 9@6ltr]bDbl
e,Itaiurororuugnqn $lcosu ry
g9l 616 ul tuuu$ri oetn ucoqul Lb el DlGelmr'

vi
V" $J.#%# z'{'

(SIGNATUREoFTHECANDIDATE/6.fl6uur60rruugnrTrfleircooGlulnuutl)
SUBMITTED DATE : 23-MAR-2019

a
1 903231 30209+0530