A.P.

Forest Department Recruitment Test (FDRT) - 2014 FILLED IN ON LINE APPLICATION FORM
(This is NOT a HALL TICKET)
Preserve the REGISTRATION NUMBER for all future correspondance

REGISTRATION No.:

1.

a) b) c) d)

Candidate's Name Father's Name / Guardian's Name Date of Birth (as per 10th Class / equivalent) Gender

: : : : : : : : : :

PILLALA NIRMAL MANI KUMAR SARADA LAKSHMI 01-May-1990 Male

Forest Beat Officer

336168

2. 3.

Post(s) Applied a) Qualification(s) b) Board / University

Inter(10+2) or Equivalent OTHERS 2009 Telugu No

c) Year of Passing
4. a) Medium Selected for Examination b) Urdu Translation Required Center for Appearing the Examination 1st Preference 2nd Preference Community

5.

: :

SRIKAKULAM VIZIANAGARAM 7. Creamy Layer 9. Ex-Servicemen : : No No No

6.

: OC : Not Applicable : Yes : Srikakulam

8.

NCC Certificate

10. Government Employee

12. District to which you are Local 13. a) Places of Study : 4th Class 5th Class 6th Class 7th Class 8th Class 9th Class 10th Class
Srikakulam Srikakulam Srikakulam Srikakulam Srikakulam Srikakulam Srikakulam

11. Scheduled Area :

b) Post(s) Preference : Preference - 1 Preference - 2 Preference - 3 Preference - 4 Preference - 5 Preference - 6 b) Identification Marks :
i) A MOLE ON THE LEFT JAW Forest Beat Officer

14. a) Address for Correspondence :

P.NIRMAL MANIKUMAR MIG-203 APHB COLONY, ZP BACKSIDE SRIKAKULAM SRIKAKULAM PIN Code : 532001

ii)

A MOLE ON THE LEFT HAND

c) Contact Telephone No.(Mobile No.) :7893743146 15. Fee Particulars : a) Payment through : b) Transaction ID / Reference ID : c) Total Amount Paid (Rs.) : Declaration :

d) Email ID : nirmalmanikumar@gmail.com 16. Physical Measurements (in Cms) :

(Other than Technical Asst.)

mee Seva 01VCSK000099052 300.00

a) Height : b) Chest on Expiration : c) Chest on full Inspiration :

179 90 95

I hereby solemnly declare that all the entries / statements made in the above application are true, complete and they are as per the original records / certificates possessed by me. The Certificate in original will be furnished to the authorities as and when called for. In the event of any information being found false or incorrect and ineligibility having been detected before or after the written examination, the Government can take action against me as per Rules. In case if it is detected that I misled the Andhra Pradesh Forest Department in any issue, then I will be solely responsible for all penal consequences there of, including the cancellation of selection of my candidature.

Signature of the Candidate

336168 Monday, March 10, 2014 6:07:08 PM