Applicationformer

SGX1630201318

APPLICATION FORM FOR Short Service Commission Executive{GS(Hydro)} JUN 16 BATCH

(Affix Photograph)

(UNMARRIED MALE/ FEMALE CANDIDATES ONLY)FOR INDIAN NAVY OFFICE USE ONLY

Code No: For Office use only: Application No:

VALID / INVALID

1. CHOICE OF ENTRY : [3] SSC(NA) [2] SSC{GS(X)} [1] SSC{GS(Hydro)}

2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:

NAME: niraj prasad DATE OF BIRTH: 1994/08/25

FATHER'S NAME: rajesh FATHER'S OCCUPATION: horticulture contractor

DOMICILE: Maharashtra GENDER: Male

BLOOD GROUP: NCC: No

3.NATIONALITY: INDIAN 4.MARITIAL STATUS: Unmarried 5.EMAIL: [email protected]

6. ADDRESS: PERMANENT PRESENT

bldg 7 flat 2 prakash colonysalisbury park gultekdi bldg 7 flat 2 prakash colonysalisbury park gultekdi

DISTRICT pune pune

STATE Maharashtra Maharashtra

PINCODE 411037 411037

TELEPHONE --NA-- 020-24271368

MOBILE --NA-- 8793876332

7. EDUCATION PARTICULARS:

Qualification Stream Year of Passing Percentage

B.E Civil Engineering 2015 72.11%

Maximum Marks Marks Obtained Maximum Marks Marks Obtained

1st Semester 0 0 2nd Semester 1775 1479

3rd Semester 750 460 4th Semester 750 507

5th Semester 750 478 6th Semester 750 511

7th Semester 750 485 8th Semester 750 605

8. I HAVE NOT ATTENDED ANY SSB INTERVIEW TILL DATE

DECLARATION

1.I, hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never beenarrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police.2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief.3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.4. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiated against me for fraudulent entry and falsification of GOIdocuments. I also accept that no TA/DA will be admissible to me in such cases.5. I have completed my B.E as on date.

NOTE:Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ORDINARY POSTONLY. You will be intimated via Email or SMS regarding your SSB Call-up, if shortlisted. Kindly check your Email inbox regularly.

Place ______________ Date _____________ September 7, 2015, 12:07 am

Signature of Applicant

Documents

Applicationformer