Applicant Details

Application Sequence No.

100012056

Notification Details ( Examination )

Advertisement/Notification Number
PRPB-ONE-1(135)/2018

Department and Post Name

UTTAR PRADESH FIRE BRIGADE Service Fireman Direct Recruitment 2018

Gender
Male

Order of Post - Preference 1

Fireman

Have you applied for the above mentioned post in 2016

No

Candidate Personal Details

Applicant First Name

SHUBHAM

Applicant last Name

YADAV

DOB (dd/MMM/yyyy)
09/Oct/1997

Age as on 01/Jul/2018
20 Years 8 Months 23 Days

Father/ Guardian's Full name

PAWAN KUMAR YADAV

Mother's Name
KANCHAN YADAV

Marital Status
Single

Mobile Number
8009935771

Email ID
sy09101994@gmail.com

Confirm Email ID
sy09101994@gmail.com

Applicant Full Name

 SHUBHAM YADAV

Application Status
Submitted

Candidate Domicile and Category Details

DOMICILE STATE
U.P

APPLIED CATEGORY
OBC

Candidate Domicile and Category (OBC/SC/ST) Certificate Details

Category Certificate Issuing Authority

OBC

Category Certificate issue Date

29/Jun/2016

Category Certificate Serial No

275163005879

Domicile Certificate Issuing Authority

OBC

Date of Issue of Domicile

15/May/2013

Domicile Certificate Serial No

273132025331

Other Details of Candidate

DFF ( Dependent on Freedom Fighter)

NO

Served UP Home Guard for 3 Yrs ?

No

Are you Ex Serviceman?

No

Are you UP. Govt. Employee ?

No

Address Details

Present Address Line 1

151

Present Address Line 2

SHAH KHERA ARJUN GANJ

City / District
LUCKNOW

Present Address Police Station

GOSAIGANJ

State/U.T
 Uttar Pradesh

Present Address Pin-code

226002

Present Address District/City

LUCKNOW

Permanent Address same as Present Address

Yes

Educational Qualification

High School/10th Details

High School/ 10th Qualification Name of Passing Board/ School

High School/ 10th IDEAL ELEMENT I C ARJUN GANJ

Date of Passing Roll Number

10/Jun/2011 1148623

Is Grade System Total Marks Obtained

Yes 365

Maximum Marks Percentage of Marks/Equivalent percentage

600 value as per CGPA
60.83

Intermediate/ 12th Details

Intermediate/ 12th Qualification Name of Passing Board/ School

Intermediate/ 12th LUCKNOW PUBLIC I C

Date of Passing Roll Number

05/06/2013 0935989

Is Grade System Total Marks Obtained

No 338

Maximum Marks Percentage of Marks/Equivalent percentage

500 value as per CGPA
67.6

Preferential Qualification Details

Preferential Qualification Select applied Certificate Date of

Option Number Issue

Obtained a B certificate of National Cadet Corps No

Obtained O LEVEL Certificate in Computer from DOEACC or No

NIELIT Society

Served in the Territorial Army for a minimum period of two No

years
Candidate Photo

Candidate Signature

Declaration

घोषणा / Declaration

1. म एतत वारा घोषणा करता हूँ क मने पर ा हे तु नगत व तत

ृ सच
ू ना/ व ि त जो क वेबसाइट http://prpb.gov.in पर उपल ध है , म
उि ल खत सभी ावधान को यान से पढ़ लया है तथा उन ावधान का पालन करने का वचन दे ता/दे ती हूँ |

I hereby declare that I have read all the provisions in the detailed notice/notification available on website
http://prpb.gov.in of the examination carefully and hereby undertake to abide by them.

2. म घोषणा करता हूँ क म रा यता, आयु सीमा, शै क यो यता इ या द क यथा न द ट पा ता क सभी शत को पण

ू करता / करती हूँ |

I declare that I fulfil all the conditions of eligibility regarding nationality, age limits, educational qualifications etc. as
prescribed.

3. म घोषणा करता / करती हूँ क अनस

ु ू चत जा त / अनस
ु ू चत जनजा त के उमीदवार के प म आर ण के लए मेरा दावा स य एवं सह है
तथा म सचू ना / व ि त म दए गए ा प म जा त माण प धा रत करता / करती हूँ |

I declare that my claim for reservation as SC /S T candidate is true and correct and I am in possession of caste
certificate in the prescribed format given in the Notice / notification.

या

म घोषणा करता / करती हूँ क OBC उ मीदवार के प म आर ण के लए मेरा दावा वा त वक एवं सह है तथा म सच ू ना / व ि त म दए
गए ा प माण प जो दनांक 01/04/2018 के बाद का नगत है , धा रत करता / करती हूँ | म यह भी घोषणा करता / करती हूँ क म उ०प०
सरकार वारा आदे श 13/22/16/92/तक-iii-का-2014 दनांक 17.12.2014 म व णत OBC ेणी के मी लेयर (creamy layer) से
स बं धत वग से नह ं हूँ |

I declare that my claim for reservation as OBC candidate is true and correct and I am in possessio n of caste certificate
which is issued after 01/04/2018 in the prescribed format given in the notice/notification. I also declare that as per Govt.
order No.13/22/16/92/TC-iii-का-2/2014 dated 17.12.2014, I do not belong to the Category (creamy layer) mentioned
 therein.

4. म घोषणा करता हूँ क (शाद शद

ु ा पु ष अ यथ हे त)ु मेर एक से अ धक जी वत प नी नह ं है या (शाद शद
ु ा म हला अ यथ हे त)ु म यह
घोषणा करती हूँ क मने कसी ऐसे पु ष से शाद नह ं क है िजसक पहले से ह एक जी वत प नी है |

I declare that I have no more than one wife living (For Married Male) OR I declare that I have not married a man already
having a living wife (For Married Female).

5. म यह भी घोषणा करता / करती हूँ क मझ

ु े व ध वारा था पत कसी भी यायालय के वारा कभी भी दोषी नह ं ठहराया गया है |

I also declare that I have never been convicted by any court of law.

6. म यह भी घोषणा करता / करती हूँ क मझ

ु े सरकार सेवा से कभी भी बखा त अथवा हटाया नह ं गया है न ह प रवी ा अव ध के दौरान मेर
सेवाओं को समा त कया गया है |

I further declare that I have never been dismissed or removed from Govt. Service or my service been terminated during
probation.

7. म एतत वारा घोषणा करता / करती हूँ क इस आवेदन प म क गयीं सम त वि टयां / कथन मेरे ान और व वास के अनस ु ार
वा त वक, पण ू और सह ह तथा म नधा रत नयम / अ धसच ू ना के अनसु ार पा ता के सभी मानदं ड को परू ा करता / करती हूँ कसी भी
सचू ना के झूठा या गलत पाये जाने अथवा अपा ता क ि थ त म, मेरे चयन से पवू या चयन के उपरा त कभी भी नयमो के अनस ु ार बोड मेरे
व कायवाई कर सकता है , य द यह पता चलता है क मने कसी भी मु े पर बोड या नयिु त ा धकार को गुमराह कया है , तो इसके लए
म परू तरह से वयं िज मेदार होऊँगा िजसमे अ य दं डा मक कायवाह के साथ व धक कायवाह भी सि म लत होगी तथा उसके प रणाम
व प सभी दं ड का भागी होऊँगा

I hereby declare that all the entries/statements made in this application are true, complete and correct to the best of my
knowledge and belief and I fulfill the eligibility criteria as per the relevant rules/notification. In the event of any
information being found false or incorrect or ineligibility being detected before or after selection the Board or appointing
authority can take action against me as per rules in case it is detected that I have mislead the Board on any issue and I
will be solely responsible for all penal consequences thereof, including but not limited to penal action under the law.

Payment Details

Amount
400

Payment Mode
online

Payment Status
Payment Success

Payment Transaction No.

IGAFGILSX5

Order Id
10001205620190124153343802

Version 13.06.01