STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
Stenographer Grade µC¶and µD Examination, 2019

REGISTRATION NO: 40000828229

APPLICATION IS PROVISIONALLY ACCEPTED

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFIC NAME
SWETA RANI - SURENDER SINGH AMARJEET KAUR
5. DATE OF BIRTH 6. AGE AS ON
7. GENDER 8. CATEGORY
(DD/MM/YYYY) 01/01/2020
09/02/1993 26.1 FEMALE OBC
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO -

10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION

CITIZEN OF INDIA A MARK ON RIGHT FEET
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
CENTRAL BOARD OF SECONDARY EDUCATION
6324704 2008
(CBSE)
15. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ? 16. DO YOU POSSESS KNOWLEDGE
OF STENOGRAPHY ?
- YES
17. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
CHANDIGARH ( 1601 ) MOHALI ( 1406 ) AMRITSAR ( 1404 )
18.WHETHER EX- 18.1. HAVE YOU ALREADY 18.2. LENGTH OF SERVICE IN 18.3. DATE OF DISCHARGE
SERVICEMAN (ESM) ? JOINED A CIVIL POST BY ARMED FORCES ( IN YEARS ) FROM ARMED FORCES
AVAILING BENEFIT OF (DD/MM/YYYY)
RESERVATION FOR EX-
SERVICEMAN (ESM) ?
NO - - -
19. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION) ?
NO
19.1 WHETHER SCRIBE IS REQUIRED ? 19.2 WILL YOU MAKE YOUR OWN 19.3 IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
NO - -
 20. LANGUAGE/ MEDIUM OF SKILL TEST 21. POST(S) APPLYING FOR
ENGLISH BOTH (STENOGRAPHER GRADE C AND GRADE D)
22. WHETHER SEEKING AGE RELAXATION ? 22.1 IF YES,INDICATE CODE
YES 02-OBC
23. QUALIFICATION DETAILS 24. DO YOU WANT TO MAKE AVAILABLE YOUR
PERSONAL INFORMATION FOR ACCESSING JOB
OPPORTUNITY IN TERMS OF DoP&T'S O.M
NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
M.COM. (26) YES

ADDRESS DETAIL
25. POSTAL ADDRESS 26. PERMANENT ADDRESS
VILLAGE-TALAPUR POST OFFICE-BHAKU MAJRA VILLAGE-TALAPUR POST OFFICE-BHAKU MAJRA
TEHSIL-CHAMKAUR SAHIB TEHSIL-CHAMKAUR SAHIB
DISTRICT: RUPNAGAR DISTRICT:RUPNAGAR
STATE: PUNJAB STATE: PUNJAB
PIN : 140112 PIN : 140112
MOBILE NO: 9354263166 EMAIL: ravisingh051990@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED - - -
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF
THE NOTICE OF THE EXAMINATION.

2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF
ANY INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING
DETECTED BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 12/10/2019 1:03:18 PM