ane Ps Conk litre srt DOE) ¥ uPSc) NG aad PUBLIC SERVICE COMMISSION Application details of Registration-Id: 12133810155 for Combined Defence Services Examination (II) - 2021 fete dem 12133810155 aferfera wen ar wan (1) - 2021 & fry andar fer PART -1/Mm-1 Name /-H: \VIKASH KUMAR KHUNTE Gender / fer: Male Date of Birth / ora fafU: 12-01-1999 Name / far eT Father Mother's Name / 51 1 SANTOSH KUMAR KHUNTE ANNU DEVI KHUNTE Nationality / amfewm: Indian Maca statue (PORE amare Community / ere General o you belong to Minority 1A SA HETRRT Ne Fee Remission claimed / —, ome: ® RAILWAY COLONY AKALTARA BRALTARA ‘dross / War: District : Janar-champa StoteUT# Chhattisgarh Picode : 495552 Mobile No. /siemget: 6265746877 email / E20: vkumar8149@gma.com Alternative e-mail / Rees vikashkumarkhunteo112@gmai.eom Educational Qualification / Passed/Appsared/Appearing the final year degree or equivalent examination (with Physies and tee aie Mathematics t 1042 level ‘adhaar Card. ~ X9000000(1252 Photo Identity Card / Wie! Note: Please provide the photo identity card number in Online eM: ‘Application Form and remember to carry the same at the time of Personality ‘Test/Examination venue. ‘Commercial Pitot Licence Issued by DGCACIndla) wheter rae Te No Sic (area) rer a) Preferences / aaat: ‘Whether having/tikely to hhave NCCC’ Certificate Sr. Division(Aarmy/Navy/ AFA) wT ard TH TRA one sar Pe RsetCaT/ saaara Bor serait) 87 free aA ioe: ‘Whether Serving in Armed Forces / war dea aed wna No ‘Whether belong to Sainik School / Fa aT APE RET No a eau Teds: IMA: 1 NA: 0 | AFA: 0 | OTA: 4 hitpslupsconline.ncrvprintanp hp ?tno=QUJ6Y]VCLUItelhwXpSSEYSSWHSOTOOsi2ain0n4 LUPSC - Candidate's Applicaton Detals (Registraton14: 12133810155) PART =11 / MMt=11 [Fee Payment Detalls,Photograph, Signature, Photo Identity Card Document & Examination Centre of Reglstratlon-Id: 12133810155) (eefteror ar 112133810155 er yew eras Rees, Mv, eer, whet aT we eee ate wen Registration ta / ttre se 12133810155 Htransaction-1a / 8 aa TKOBGOMYTE Transaction Date / S27 # 24-08-2021 Fee Pal (In Re) / (Tart rr as (FH) 200) Jagency Name / Wet e150 State Bank of Tal Mode of Payment / Ta #1 ATE Internet Banking Photograph / WET] signature / rea | Phot Ment Crd Dosument/ | Pte a Declaration 1, Thereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect, or ineligibility being detected before or after the examination, action can be taken against me dy the Commission as per the provision given in the ‘otification. ame ts earch gf ae one AAR are fe a eh oe Ae rrr ote Rare one we BI ate A ET TET ear RT Mg TB HT aT UR rH SHEP OTT ATH OT TT TAT H Re ATE ERT kerr AL freq artarg at or wordt 81 2. Ihave read the provisions in the rules and the notice of the Commission carefully and hereby undertake to abide by ther. I further declare that 1 full all the conditions of eigibity regarding age limits, educational qualifications kc, prescribed for admission to the examination. Pe oe yes Re wR wee Ren @ oe Uae ga og a was Ree Ae oA ae ameeryoeeh A, clan 3 wb Bg ede ay or, res ee on a ee crac at eo ea a oa ee 3. T have informed my Head of Office/Department in writing that 1 am applying for this examination. * * Applicable for those who are already in government service/similar organizations or government owned industrial Undertakings whether in permanent or temporary capacity or as work charged employees other than casual or daily rated employees or those serving under public enterprises. 2B wh ere Poa Barner eA es awe fe 8 A ges lla & fhe ade we eT / ee I + a guia & mere A am, a uea 8 el aeerd Sayre are sey eT art ava shears Supe A eh anwar ree a Bata fAAEG tet Pew va we ares woke ah oh Bere el arta we we nee eater var ara ah} samt A onkea aH hitps/lupscontine nc invpintanpahp?tno=QUJGYVCUUttelhwR2XpSSEYSSWASOTOSsi2ain0n4 hitpssupecontine nic nvpintanp ahp ne LUPSC - Candidate's Applicaton Detals (Registraton14: 12133810155) UIBYIVCUUIhwRXPSSEYISWHSATOS 39