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Application Form Draft Print For All

The document is an incomplete application for the Stenographer Grade C and D Examination, 2019, submitted by Sahil Uttam. It includes personal details such as name, date of birth, and examination preferences, along with a declaration of the applicant's acceptance of the examination terms. The application indicates that the fee payment is not exempted and provides contact information for the applicant.

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Sahil Uttam
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10 views2 pages

Application Form Draft Print For All

The document is an incomplete application for the Stenographer Grade C and D Examination, 2019, submitted by Sahil Uttam. It includes personal details such as name, date of birth, and examination preferences, along with a declaration of the applicant's acceptance of the examination terms. The application indicates that the fee payment is not exempted and provides contact information for the applicant.

Uploaded by

Sahil Uttam
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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STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI


110003
Stenographer Grade µC¶and µD Examination, 2019

REGISTRATION NO: 30000708277

APPLICATION IS INCOMPLETE
1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFIC NAME
SAHIL UTTAM - ANAND KAMAL UTTAM SUPRIYA KATIYAR
5. DATE OF BIRTH 6. AGE AS ON
7. GENDER 8. CATEGORY
(DD/MM/YYYY) 01/01/2020
07/07/2001 18.5 MALE OBC
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO -

10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION


CITIZEN OF INDIA SCAR ON HEAD
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
COUNCIL FOR THE INDIAN SCHOOL CERTIFICATE
6519729 2017
EXAMINATIONS (ICSE)
15. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ? 16. DO YOU POSSESS KNOWLEDGE
OF STENOGRAPHY ?
- YES
17. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
KANPUR ( 3009 ) LUCKNOW ( 3010 ) PRAYAGRAJ ( 3003 )
18.WHETHER EX- 18.1. HAVE YOU ALREADY 18.2. LENGTH OF SERVICE IN 18.3. DATE OF DISCHARGE
SERVICEMAN (ESM) ? JOINED A CIVIL POST BY ARMED FORCES ( IN YEARS ) FROM ARMED FORCES
AVAILING BENEFIT OF (DD/MM/YYYY)
RESERVATION FOR EX-
SERVICEMAN (ESM) ?
NO - - -
19. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION) ?
NO
19.1 WHETHER SCRIBE IS REQUIRED ? 19.2 WILL YOU MAKE YOUR OWN 19.3 IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
NO - -
20. LANGUAGE/ MEDIUM OF SKILL TEST 21. POST(S) APPLYING FOR
ENGLISH BOTH (STENOGRAPHER GRADE C AND GRADE D)
22. WHETHER SEEKING AGE RELAXATION ? 22.1 IF YES,INDICATE CODE
NO -
23. QUALIFICATION DETAILS 24. DO YOU WANT TO MAKE AVAILABLE YOUR
PERSONAL INFORMATION FOR ACCESSING JOB
OPPORTUNITY IN TERMS OF DoP&T'S O.M
NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2) YES

ADDRESS DETAIL
25. POSTAL ADDRESS 26. PERMANENT ADDRESS
HIG 75 JARAULI-2 BARRA-8 HIG 75 JARAULI-2 BARRA-8

DISTRICT: KANPUR NAGAR DISTRICT:KANPUR NAGAR


STATE: UTTAR PRADESH STATE: UTTAR PRADESH
PIN : 208027 PIN : 208027
MOBILE NO: 9140029794 EMAIL: sahiluttam.35@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF
THE NOTICE OF THE EXAMINATION.

2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF
ANY INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING
DETECTED BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 30/09/2019 10:27:59 AM

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