Registration Date:25-09-2017 03:32 PM Print Date:15-02-2018 01:07 AM

INDIAN ARMY
Directorate General of Recruiting
SSC(Tech)-51/148612

SSC(Tech) Application Details

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Personal Details
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1. Roll No SSC(Tech)-51/148612
2 Course Applied For : SSC(Tech)-51
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3. Candidate's Name (As per Matriculation TIWARI RAJAT POTRADHAR

Certificate)
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4. Father's/Guardian's Name POTRADHAR TIWARI

5. Mother's Name CHANDNI TIWARI
6. Date of Birth (As per Matriculation 22-08-1995
Certificate)
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7. Nationality INDIAN
8. If Other Nationality
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9. Marital Status Unmarried

10. Gender Male
11. Mobile No 9096059609
12. Email Address rajattiwari6969@gmail.com
13. Aadhar No XXXXXXXX5743
14. Permanent Address Correspondence Address
Address A/204,MAHAVIR Address B/201,GURU
SHRUSTI,BEHIND CASTLE
MADHUR BLDG,JAHANGIR
HOTEL,NAVAPUR IRANI
ROAD ,BOISAR(W) ROAD,KHAIRAPHAT
AK,BOISAR(E)
City / Town / Village BOISAR City / Town / Village boisar
State Maharashtra State Maharashtra
District Thane District Thane
PIN 401501 PIN 401501
15 Previous SSB Attepmts
Registration Date:25-09-2017 03:32 PM Print Date:15-02-2018 01:07 AM

INDIAN ARMY
Directorate General of Recruiting
SSC(Tech)-51/148612

(a) Entry (b) Location (c) Year/Month (d) Result

16 Education Details
(a) Type of School OTHERS
(b) Roll No of 10+2 Examination OR Diploma M023481
(c) Whether Diploma holder or not No

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(d) Aggregate % of Marks Obtained in Class 64.33
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(e) Engineering Stream Applied For Mechanical

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(f) Specified Stream Mechanical Engineering
(g) Date Of Joining Engineering Course 07-08-2013
(h) Date of Completion of Engineering 24-08-2017
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Course
(i) Name of College/Institute Theem college of engineering
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(j) Name of University Mumbai University

(k) Type of University State University
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(l) State in which University Located Maharashtra

17. Marks obtained in Graduation
Note 1. The CGPA/Grades must be converted into marks as per the formula adopted by
the concerned University for filling ‘Total Marks’ and ‘Marks Scored’ in the under
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mentioned table.
Note 2. In case of yearly system of examination, the candidates to divide ‘Total Marks’
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and ‘Marks Scored’ into two equal parts to fill in the First and Second semester marks
of the respective year accordingly.
Semester / Year Total Marks Marks Scored % of Marks Cumulative % of
Marks scored
Semester 1 650.00 359.00 55.23 55.23
Semester 2 / 800.00 482.00 60.25 58.00
Year 1
Semester 3 675.00 405.00 60.00 58.64
Semester 4 / 825.00 553.00 67.03 60.98
Year 2
Semester 5 750.00 461.00 61.47 61.08
Semester 6 / 825.00 501.00 60.73 61.02
Year 3
Semester 7 750.00 510.00 68.00 62.01
Semester 8 / 700.00 517.00 73.86 63.40
Year 4

Declaration
Registration Date:25-09-2017 03:32 PM Print Date:15-02-2018 01:07 AM

INDIAN ARMY
Directorate General of Recruiting
SSC(Tech)-51/148612

1. I have read the course notification as well as the instructions for filling this application. I
undertake to abide by all instructions /guidelines mentioned therein.
2. I undertake not to have any objections in the event of my final selection on allotment of
any Arms/Service in the interest of the organization.
3. I have never been debarred from appearing in any examination by UPSC.
OR

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I was debarred in the following UPSC exam_________________________.
4. I have never been arrested or convicted by a criminal court or involved in any case.

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OR
I have been arrested/convicted/implicated in the following cases:-
(a)
(b)
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5. I undertake not to make any claim or compensation if at any stage of selection, my
ineligibility is detected and my candidature is cancelled as a result thereof.
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6. This is the only application submitted by me for this course. I understand that in case
any other application filled by me is detected for this course at a later date, all my
application will be cancelled.
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7. Any misinterpretation and wrong declaration concealment of information in the

application will render my candidature to be cancelled and I may be debarred from this
course.
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8. I have never been withdrawn from NDA, IMA or OTA or any service training Academy
on disciplinary grounds.
9. I am employed with_____________ and I have informed my employer in writing that I
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am applying for commission in the Army.

10. In the eventuality of being recommended by SSB, I will have no objection to being
medically examined by the board of Male/Female doctors provided a lady medical officer
is present (applicable only to lady cadets).
11. I undertake to be debarred from future attempts and would accept cancellation of my
candidature for the present course, if at any stage of selection, I am found to be
indulging in any violation of local orders concerning discipline aspects.
12. I undertake not to marry till I complete the full training at the training academy, in case
inducted. I also understand that in case of my final selection, my appointment will be
provisional subject to satisfactory verification of my antecedents by concerned Civil/
Police/Education authorities as applicable.
13. In case of my final selection and subsequent joining the Academy, I undertake to
reimburse the complete cost of training as specified by the Academy authorities if I
choose to resign.
14. I affirm that all information supplied by me as above is true and correct, and I agree that
no change in particulars once filled by me will be permitted, I also fully understand that if
at any stage, it is discovered that any attempt has been made by me to wilfully conceal
or misrepresent the facts, my candidature may be summarily rejected or employment
terminated.
Registration Date:25-09-2017 03:32 PM Print Date:15-02-2018 01:07 AM

INDIAN ARMY
Directorate General of Recruiting
SSC(Tech)-51/148612

Place:
Date:15-02-2018 12:30 AM

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Signature of Applicant

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Note
1. After applying online, candidates are requested to take a print out and paste their self-
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attested photograph in blue ink in the given space. The candidate must carry the
application along with the original certificates and the certificates from the college duly
certified by the Principal regarding conversion of cumulative grades into percentage of
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marks with a valid proof of identity to the Selection Centre as and when called for the
SSB. If candidate does not carry the above mentioned documents to the concerned
Selection Centre for his SSB, his candidature will be cancelled. There is NO need for
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sending any printout of the application to the Recruiting Directorate.

2. Recruiting Directorate reserves the right to shortlist and to fix cut off percentage of
marks for SSB interview as per organizational Requirement. No representation will be
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entertained in this aspect.

CERTIFICATE BY PRINCIPAL/HEAD OF THE TECHNICAL INSTITUTIONS TO BE
SUBMITTED BY FINAL YEAR/SEMESTER CANDIDATES
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Certified that Shri ________________________________________S/o

__________________________________ Date of Birth_______________________ is
studying in final year/final semester of B.E/B.Tech ______________________ (Branch of
Engineering) in this University/College/Institute and his final year/semester examinations will
be over by __________________.

Place:______________ Signature:______________
Date: _______________ Designation:______________

Note: Certificate signed by Heads of Departments will not be acceptable.