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901070019114

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30 views2 pages

901070019114

sadasdasd

Uploaded by

Ashish Bisht
Copyright
© © All Rights Reserved
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
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Application Form 901070019114

Advt. No. CEPTAM-09/STA-B DRDO ENTRY TEST-2018 Crucial date of Eligibility-29-08-2018

For Office Use Only


Online Application Number: 901070019114
Generated On Date: 27/08/2018 18:47

8. Nationality: INDIAN
9. Identity Proof
9. Type: Aadhaar Card No. 8867 2321 9309
10. Gender: Male

1. Post Code & Post Name: [STA-B]-0107-Computer Science


11. Contact Details:
2. Exam City Preference:10-DEHRADUN, 11-DELHI NCR, 08-
CHANDIGARH a) Correspondence Address: GAYATRI ENTERPRISES,
3. Candidate’s Name: NARENDRA KUMAR NEAR SANT TENT HOUSE S.D.H. INTER COLLEGE ROAD,
4. Father’s Name: RANJIT SINGH BARA BAZAR, THAKURDWARA
5. Mother’s Name: GAYATRI DEVI District: Moradabad City: THAKURDWARA
6. Date of Birth: 05/12/1992 State: UTTAR PRADESH Pincode: 244601
Age as on Crucial Date: 25Y,8M,24D
(if Permanent Address same as Correspondence Address) [ ]
7.a) Category b) Permanent Address: VILL- PANYA MAJYARI(ADIBADRI)
[ ] Unreserved(UR) [ ] Scheduled Caste (SC) District: Chamoli City: PANYA
[ ] Scheduled Tribe (ST) [ ] OBC (Creamy Layer) State: UTTARAKHAND Pincode: 246440
[ ] OBC (Non-Creamy Layer)
c) Mobile No: 9568122652
d) Alternate No: 9456815115
e) Email ID: [email protected]

12. Essential Qualifications


a) Do you possess EQR as per CEPTAM-09/STA-B Advt. (Diploma /B.Sc.) as on crucial date of eligibility: YES[ ] No[ ]
b) Do you possess B.Sc./Diploma/Both : B.Sc.[ ] Diploma [ ] Both(Diploma and B.Sc.)[ ]

Mode of
University/ Year of Max. Marks/ Marks/ CGPA % of Marks
Qualification Degree/ Main Subject Roll No.
Board Passing CGPA obtained Secured
Qualification
HINDI
ENGLISH
MATHEMATIC
X Regular S SCIENCE 0677858 UP BOARD 2007 600.00 374.00 62.33
SOCIAL
SCIENCE
DRAWING
INFORMATIO
N
Diploma Regular 0908120126 UBTER 2013 5963.00 3810.00 64.46
TECHNOLOG
Y
c) Subject mentioned on EQR: THREE YEAR DIPLOMA
d) Higher Qualification (B.E., B.Tech, M.Sc, M.Tech, Ph.D., etc)
Are you Pursuing YES[ ] NO [ ] Have you Completed YES [ ] NO [ ]
Degree Likely Date of Completion Degree Likely Date of Completion
NA NA NA NA
13. a) Details of Application Fee of Rs. 100/- Paid (If not exempted as per Govt. rules)

Payment Method Fee Amount Payment Date Payment ID Transaction ID Status


APTC0000356071201 201808271112128001
DC 100.00 27/08/2018 TXN_SUCCESS
80827184640 10168039435092371
14. Physical Measurements:
a) Height (cm): 170.00 b) Weight(kg): 67.00 c) Visible Identification Mark: MOLE BELOW THE LIPS ON LEFT SIDE
15. Special Categories (if any) :
a) Do you belong to Minority community: Yes [ ] No[ ]
b) Domiciled in J&K during 01/01/1980 to 31/12/1989 : Yes[ ] No [ ]
c) Defence Personnel with Disability: YES [ ] NO [ ]
16.Posting Preference
Preferen
1 2 3 4 5 6 7 8 9 10 11 12
ce
Location
(City B2 A2 P1 P2 H2 A1 D2 J2 K2 A3 B1 B3
Code)
17.List of Documents Uploaded
10th class or equivalent Certificate , EQR Certificate
I hereby give my consent to disclose my particulars, score and rank of examination publically (refer 5.2 of CEPTAM-
09/STA-B Advertisement) on the website. [ ] Yes [ ] No
18. Declaration
I NARENDRA KUMAR son/daughter of RANJIT SINGH hereby declare that
a) I have read and understand all the provisions mentioned in the advertisement and undertake to abide by them.
b) All the statements made in this application are true, complete and correct to the best of my knowledge and belief.
c) I have submitted only one application for one post in response to this advertisement.
d) I understand that in the event of any information being found suppressed, false or incorrect or any ineligibility being
detected before or after the examination/recruitment, my candidature/recruitment/ appointment is liable to be cancelled.
19. Required at the time of document verification, if shortlisted

Place:

Date:

a) Left Hand Thumb Impression b) Signature of Candidate

Note:- You are NOT REQUIRED to send print out of your application to the CEPTAM/DRDO at this time. However, it is advised to
keep this application form and copy of the advertisement for claiming travel concession from Railways, and also for future
references. CEPTAM does not undertake any Detailed scrutiny of application before examination and the eligibility is verified only
after examination. Accordingly, mere allowing the candidates to appear in the examination will not be construed as a ground of
being eligible for the post applied

Online Application Number: 901070019114 , Generated on 27/08/2018 18:47

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