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    Declaration by The Candidate

    Uploaded by

    Kiran Naik
    This document contains an application form for a candidate named Shivaraj for a Group-XY position. It includes personal details like name, date of birth, qualifications, contact information, physical attributes, and a declaration signed by the candidate. The form requests three exam center preferences and indicates the candidate's first preference is ASC-7 Bangalore and second is ASC-12 Secunderabad.

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    Declaration by The Candidate

    Uploaded by

    Kiran Naik
    7 views2 pages
    This document contains an application form for a candidate named Shivaraj for a Group-XY position. It includes personal details like name, date of birth, qualifications, contact information, physical attributes, and a declaration signed by the candidate. The form requests three exam center preferences and indicates the candidate's first preference is ASC-7 Bangalore and second is ASC-12 Secunderabad.

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    Original Title

    ApplicationPDF (1)

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    This document contains an application form for a candidate named Shivaraj for a Group-XY position. It includes personal details like name, date of birth, qualifications, contact information, physical attributes, and a declaration signed by the candidate. The form requests three exam center preferences and indicates the candidate's first preference is ASC-7 Bangalore and second is ASC-12 Secunderabad.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    7 views2 pages

    Declaration by The Candidate

    Uploaded by

    Kiran Naik
    This document contains an application form for a candidate named Shivaraj for a Group-XY position. It includes personal details like name, date of birth, qualifications, contact information, physical attributes, and a declaration signed by the candidate. The form requests three exam center preferences and indicates the candidate's first preference is ASC-7 Bangalore and second is ASC-12 Secunderabad.

    Copyright:

    © All Rights Reserved
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    of 2

    Office Use

    Office Use

    Office Use

    Registration No
    16033484055

    1.Candidate Name

    SHIVARAJ

    2.Parent Name

    CHANDRASHEK

    CHANDRASHEK 3.Nationality

    Indian

    HAR KAMMAR

    HAR KAMMAR
    4.Date Of Birth

    27-08-1997

    5.Marital Status

    Un Married

    6.Qualification

    Intermediate
    EMPCB

    7.Intermediate/Voca 67

    8.Name of

    Govt of Karnataka 9.Matric Board

    Karnataka

    tional/Diploma

    Intermediate/vocatio Dept of Pre-

    Secondary

    English %

    nal/Diploma

    University

    Education

    Education

    Examination
    Board

    10.Matric Roll No

    20130358853

    11.Aggregate

    13.EMail Id

    97kammar@gmail. 14.SOAFP

    68

    12.Mobile No

    No

    15.Discharged from No

    com
    16.Stream Applied

    Group-XY

    8548816071

    Forces
    17.Identification

    none

    18.Candidate Height 164.0cm

    ASC-6 Mumbai

    21.Exam Center

    ASC-12

    Choice 3

    Secunderabad

    24.Preference for

    1st preference: Y

    mark
    19.Exam Center

    ASC-7 Bangalore

    Choice 1

    20.Exam Center
    Choice 2

    22.Permanent

    AT.

    Address

    RAMAPUR,POST Address

    RAMAPUR,POST group XY candidate 2nd preference: X

    MISHRIKOTI,TQ

    MISHRIKOTI,TQ only

    HUBLI,Dharwad,

    HUBLI,Dharwad,

    Karnataka,581196,

    Karnataka,581196,

    25.Chest Size

    30 Inch

    23.Communication

    26.Waist Size

    AT.

    29 Inch

    27.Shoe Size

    8 No.(Bata)

    DECLARATION BY THE CANDIDATE


    I hereby declare that all statements made in this application are correct.I understand that I am
    liable to be disqualified at any stage, if the information given is found to be
    incorrect/incomplete/false. I undertake to produce all original certificates and statement of marks
    and three photocopies of each, duly attested by a Gazetted Officer, at the time of appearing in the
    Selection test. I am willing to undergo physical and medical test, at my own risk and will not be
    entitled for compensation for injuries if any, sustained during such test. I am aware that the
    decision by President, CASB will be final and binding on me.

    Paste your
    photograph

    Signature of the candidate

    Signature of parent/guardian
    (If candiddate below 18 yrs on the day of filling application)

    Name(Gaurdian if applicable ) :
    Place:

    Left Hand Thumb


    impression
    ------------------------1

    60334 84055

    Date:

    -----------------------Tear off and Paste on Envelope------------------- -----------------------Tear off and Paste on Envelope-------------------

    To,
    President
    Central Airmen Selection Board
    PO Box: 11807
    New Delhi-110010

    16033484055
    Group-XY

    60334 84055

    68

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