Scribd
Upload
72 views

9.have You Been Discharged From Arm Ed Forces Before?

Shubham Shukla has applied for the position of Artificer Apprentice in the 134th batch of the Indian Navy. He is unmarried, 22 years old, and has completed his 10+2 education in 2012 with 62.2% marks. He has included his application form, identification form with photographs and signature, and notes regarding submitting his application and required documents by January 6th, 2013 for confirmation of receipt.

Uploaded by

Mayank Dandotiya
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
72 views

9.have You Been Discharged From Arm Ed Forces Before?

Shubham Shukla has applied for the position of Artificer Apprentice in the 134th batch of the Indian Navy. He is unmarried, 22 years old, and has completed his 10+2 education in 2012 with 62.2% marks. He has included his application form, identification form with photographs and signature, and notes regarding submitting his application and required documents by January 6th, 2013 for confirmation of receipt.

Uploaded by

Mayank Dandotiya
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

12/ 27/ 12

U ild D nt t e ocum ent

APPLICATIO N FO RM FO R ARTIFICER APPRENTICE 134 BATCH (UNMARRIED MALE CANDIDATES O NLY) FO R INDIAN NAVY O FFICE USE O NLY CO DE NO . VALIDITY STATUS Valid Invalid APPLICATIO N NO -A1325447387N Paste your recent colour photograph (Do not staple)

1. PERSONAL PART ICULARS AS IN MAT RICULAT ION CERT IFICAT E:NAME FAT HER'S NAME SHUBHAM SHUKLA VINO D SHUKLA 3.MARIT IAL ST AT US: Unmarrie d
PERMANENT H NO. 2A BHAGWATI COLONY PEETAL KARKHANA SINGH PUR ROAD MORAR GWALIOR GWALIOR Madhya Pradesh 474006

DAT E OF BIRT H PERCENT AGE (10+2):-

01/07/1994 62.2 %

2.NAT IONALIT Y: INDIAN


5. ADDRESS: ADDRESS DISTRICT STATE PINCODE TELEPHONE MOBILE

4.EMAIL:- [email protected]
PRESENT H NO. 2A BHAGWATI COLONY PEETAL KARKHANA SINGH PUR ROAD MORAR GWALIOR GWALIOR Madhya Pradesh 474006 7354039858

6.EDUCAT ION PART ICULARS(HIGHLIGHT ED SUBJECT S(10+2)):- Compulsory-Physics,Maths Optional-Che mistry Year of Passing 2012 Authority State from which Exam Conducting Exam Passed CBSE Madhya Prade sh Serial No. of Certificate 062577 Marks obtained 311 T otal marks Percentage 500 NO NO NO 62.2

7. NCC Certificate 8. HAVE YOU EVER BEEN ENROLLED IN ARMED FORCES BEFORE?

9.HAVE YOU BEEN DISCHARGED FROM ARM ED FORCES BEFORE?


10. VISIBLE IDENT IFICAT ION MARKS (AT LEAST T WO):(a)- a mole on toe of right le g (b)- a mole on right e ye brow

DECLARATIO N 1. I hereby declare that all the statements made in the application are true to the best of my knowledge and belief and the application has been filled up by me. 2. I have never been debarred from apperaing in any examination nor, have I ever been withdrawan from Defence T raining Establishments on disciplinary grounds, nor have I ever been arrested, prosecuted or convicted by criminal court or involved in any other case registered by the police. I have not submitted more than one application for this batch. 3. I undertake not to make any claim for compensation if at any stage of selection, ineligibility for my candidature is detected and my candidature is cancelled as a result thereof. 4. Any wilful misrepresentation of facts and concealment of information will result in the cancellation of the candidature and may debar me permanently or for a specific period from applying for future examinations. Place.................. Date.................. Signature of parent Signature of Applicant

IDENTIFICATIO N FO RM Name Fathers name SHUBHAM SHUKLA VINO D SHUKLA Application No. Date of Birth A1325447387N 01/07/1994 Signature of Applicant Affix a latest passport size photograph

Visible Identification Marks (at least two):(a)- a mole on toe of right le g (b)- a mole on right e ye brow

NOTE:1. Please forward the attested photo copies of 10th class certificate, 12th class certificate, 12th class mark sheets and Domicile certificate along with the
nausena- bhar t i ni . i / t h. php?appl at i nno=byr m t 0A23M PS09TM 7A3l Yup60A09T0A09TXQ p69PS09T . c n c i o 7 1/ 2

12/ 27/ 12

U ild D nt t e ocum ent

printout of this application( duly signed) to the POST BOX NO. 476, GOL DAK KHANA, GPO, NEW DELHI -110001 by ordinary post. Also attach Two self addressed envelops of 22x10 cm with Rs 10 stamp affixed on one envelope. The certificates are to be attested only by gazetted officer and name of the attesting officer should be legible. 2. Final receipt of the printout of the Online Application Form with system generated Application Number and all documents as mentioned in Para (1) above by 06 Jan 2013, will be the final CONFIRMATION of receipt of your Application. 3. Following is to be written on the Envelope: - APPLICATION FOR ARTIFICER APPRENTICE-134 Batch APPLICATION NO: A1325447387N Percentage in 10+2: 62.2 % Domicile State: Madhya Pradesh

December 27, 2012, 7:11 pm

nausena- bhar t i ni . i / t h. php?appl at i nno=byr m t 0A23M PS09TM 7A3l Yup60A09T0A09TXQ p69PS09T . c n c i o 7

2/ 2

You might also like