Application Form For Artificer Apprentice 138 Batch
Application Form For Artificer Apprentice 138 Batch
Code No:
Application No:
(Affix Photograph)
VALID / INVALID
A13812038714N
1. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:
NAME:
ASHOK KUMAR
DATE OF BIRTH:
1997/07/01
FATHER'S NAME:
OM PRAKASH
PERCENTAGE (10+2):
90.8
2.NATIONALITY:
INDIAN
5. ADDRESS:
3.MARITIAL STATUS:
Unmarried
4.EMAIL: [email protected]
PERMANENT
PRESENT
DISTRICT
LAKHIMPUR KHERI
LAKHIMPUR KHERI
STATE
Uttar Pradesh
Uttar Pradesh
PINCODE
262727
262727
--NA--
8447058065
TELEPHONE
MOBILE
2014
STATE BOARD
State from which Exam Passed Serial No. of Certificate Marks obtained
Uttar Pradesh
2356349
7. NCC Certificate
8. HAVE YOU EVER BEEN ENROLLED IN ARMED FORCES BEFORE?
9. HAVE YOU BEEN DISCHARGED FROM ARMED FORCES BEFORE?
10. DO YOU VOLUNTEER FOR SUBMARINE SPECIALISATION?
11. VISIBLE IDENTIFICATION MARKS (AT LEAST TWO):(a) RIGHT FOOT CUT MARK
Total marks
Percentage
500
90.8
454
NO
NO
NO
YES
DECLARATION
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 appearing in any examination nor, have I ever been withdrawan from Defence Training 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
IDENTIFICATION FORM
Name
ASHOK KUMAR
1997/07/01
(Affix Photograph)
Signature of Applicant
NOTE:
Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ordinary
post.
December 20, 2014, 8:20 pm