ONLINE APPLICATION FORMAdvt. No. CEPTAM - 08 DRDO ENTRY TEST - 2015 Cutoff/Closing Date - 8th Feb 2016

1. POST NAME & CODE TECH'A'-[0211-FITTER]2. Preference For Exam City I. 12-HYDERABAD II. 25-VISAKHAPATNAM III. 07-CHENNAI3. Candidate's Name as Recorded in X Class Certificate BALAJI BANDARU4. Father's Name VENKATESWARA RAO B5. Mother's Name MARY KUMARI B6. Date of Birth (as recorded in X Class Certificate) 20 / 04 / 1989 , Age as on Cutoff Date 26Y, 9M, 18D7. a) Category [ ] Unreserved (UR) [ ] Scheduled Caste (SC) [ ] Scheduled Tribe (ST) [ Y ] Other Backward Class

(OBC)7. b) Sub-Category [ ] Ex-Service Man (ESM) [ ] Govt. Servant (GS) [ ] Meritorious Sports

Person (MSP) [ ] Widow/Divorcee

[ ] Persons with Disability (PWD) [ ] Orthopaedically

Handicapped (OH) [ ] Hearing Impaired (HI)

[ ] Visually Impaired (VI)

For Office Use Only :

ONLINE APPLICATION NUMBER : 80211023661

Printed On Date :28 / 01 / 2016

8. Nationality : INDIAN9. Willing to serve in Remote Area # : NA10. Gender :Male [ Y ] Female [ ]

11. Contact Details (Note : All particulars given below in thehead should be maintained active till the end of recruitmentprocess) a ) Address for Correspondence

Name : MR. BALAJI BANDARU C/O : B VENKATESWARA RAO D NO 4-132 DOKIPARRU

City/State: GUDLAVALLERU , ANDHRA PRADESH Pincode: 521332 , Landline No:

b ) Permanent Address

Name : MR. BALAJI BANDARU C/O B VENKATESWARA RAO D NO 4-132 DOKIPARRU

City/State: GUDLAVALLERU , ANDHRA PRADESH Pincode: 521332 , Landline No:

c ) Mobile No +91 - 9177501738 d ) Email bandarubalaji1@gmail.com

12. a) Educational Qualifications (Must mention all completed/result awaited/appearing)

Qualification Main Subjects / Tradeas mentioned on theCertificate / Degree ofEQR

University / Board / RollNo.

Year ofPassing

Durationof Course(In years)

MaximumMarks /CGPA

Marks /CGPAObtained

% of MarksSecured

X NA APBSE 0126220 2004 NA 600 342 57 XII ITI FITTER NCVT 1616 2007 2 700 508 72 B.Sc Diploma Graduation PostGrad. OTHERS1 OTHERS2

12. b) Higher Qualification [for post of STA 'B' / Tech 'A'] Have you Completed or pursuing M.E/M.TECH/PhD/M.Sc./B.Tech./B.E./AMIE/AMIETE etc.? YES [ ] NO [ Y ] Institute Name Qualification Status Completion / Likely

Completion Date

13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)

Payment Method Fee Amount Payment Date Payment ID Transaction ID Status 1161 50.00 2016-01-28 09:44:02 47930678 127170391 Processed

14. Employment Record in Govt./PSU/Autonomous Body etc. (If any)

Name of Organization Post Held Pay Scale /Grade Pay

Period From(dd/mm/yyyy)

Period to(dd/mm/yyyy)

Nature of DutiesPerformed

15. Important Endorsements

a) (i) Type of ID Proof : VOTER ID CARD ID No.: XWM0293662 (ii) Height (cm) : 164 (5 Feet 4 Inch) Weight (kg) : 60 Identification Mark : A MOLE ON THE LEFT PALM (iii) Driving License : [for post of vehicle operator 'A' only]

(ii ) Two / Three Wheelers: (i ) LMV : (i ) HMV :

(b) For the serving defence personnel only, claiming benefit of Ex-Serviceman

Name of Unit Rank Date ofJoining

Date ofDischarge

CO Name Contact NO.

16. Other relevant information (If any)

17. Declaration I BALAJI BANDARU son/Daughter of VENKATESWARA RAO B hereby declare that a) I have read and understood 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 orafter the examination/recruitment my candidature/recruitment/appointment is liable to be cancelled.

18. Required at the time of document verification/trade test/interview, if shortlisted.

Place :

Date :

a) Left Hand Thumb Impression b) Signature of Candidate

19. List Of Documents Uploaded 10th Class or Equivalent Certificate , EQR , Caste Certificate

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 alsofor future references. CEPTAM does not undertake any scrutiny of application before examination and the eligibility is verified only afterexamination. Accordingly, mere allowing the candidates to appear in the examination will not be construed as a ground of being eligible forthe post applied.

# for details, read CEPTAM-08 advertisement

ONLINE APPLICATION NUMBER : 80211023661 , Printed On Date :28 / 01 / 2016