Application Form

Application Registration No. 2310004272

Post Category TECHNICAL OFFICER/C

Post code/Post Applied For DR-10 / TECHNICAL OFFICER/C

Discipline ELECTRONICS

Applicant Name SAKSHI S PANDAGALE

First Name SAKSHI

Middle Name SHAKYARATNA

Surname PANDAGALE

Father's Name SHAKYARATNA Y PANDAGALE

Mother's Name NIRMALA S PANDAGALE

Marital Status SINGLE

Date of Birth (DD-MM-YYYY) 23-10-2001

Age as on 22-05-2023 21 years, 6 months and 30 days

Gender FEMALE

Category SC

Name of Caste: HINDU MAHAR

Caste Certificate No. : MSC/SR/SC/K7938/2004

Issue Date of caste certificate : 28-01-2005

Serial number of caste as per Central List : 37

Religion HINDU

Nationality INDIAN

State of Domicile MAHARASHTRA

Are you from PwBD (Persons with Benchmark Disabilities)

NO
category?

Are you an Ex-Servicemen? NO

Defence Personnel disabled in operation during hostilities with any

foreign country or in a disturbed area and released as a NO
consequence ?

Are you seeking relaxation under Meritorious sports person? NO

Are you presently employed? NO

Communication Details

Correspondence Address 57 MANDAKINI

ANUSHAKTINAGAR
MUMBAI
MAHARASHTRA 400094
City / Village MUMBAI
District MUMBAI
 State MAHARASHTRA
Pincode 400094

Permanent Address 57 MANDAKINI

ANUSHAKTINAGAR
MUMBAI
MAHARASHTRA 400094
City/Village MUMBAI
District MUMBAI
State MAHARASHTRA
Pincode 400094

Mobile No. 9869637383

E-Mail ID sakshipandagale23@gmail.com

Aadhaar No. XXXXXXXX9488

Educational Details

Candidates who have their marks in CGPA should convert them into percentage.

Maximum Obtained Duration of Month & Year

Qualification Discipline/Degree Name of School/College/Board Percentage
Marks Marks Course of Passing

ATOMIC ENERGY CENTRAL

SSC -- 500 455 91.00 -- 05-2017
SCHOOL MUMBAI

ATOMIC ENERGY CENTRAL

HSC -- 500 418 83.60 -- 05-2019
SCHOOL MUMBAI

INDIAN INSTITUTE OF
B.Tech. (ELECTRONICS AND
UG Degree INFORMATION TECHNOLOGY 10 7 70.00 4 05-2023
COMMUNICATION)
NAGPUR

Centre For Examination (City Preferences)

Preference 1 : MUMBAI Preference 2 : PUNE Preference 3 : NAGPUR

45.127.199.132

02-05-2023 10:19PM

Declaration :
I hereby declare that all 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 at any stage or not satisfying the eligibility criteria according to the requirements of the post, my candidature/ appointment is liable to be
cancelled/terminated.

(Signature of the candidate)

Name of the candidate: SAKSHI S PANDAGALE

Application Registration No.: 2310004272