STAFF SELECTION COMMISSION

REGISTRATION NUMBER : 81000237441

BASIC DETAILS
1a. AADHAAR NUMBER 681816286542
1c. AADHAAR ENROLMENT NUMBER -
1d. TYPE OF ID -
1e. ID NUMBER -
2a. NAME SHAIJAL K M
2c. HAVE YOU EVER CHANGED NAME? NO
2d. NEW NAME -
3a. FATHER'S NAME KOYA K M
4a. MOTHER'S NAME HASEENA K M
5a. DATE OF BIRTH (DD/MM/YYYY) 31/05/1997
6. MATRICULATION (10TH CLASS) EXAMINATION DETAILS :
(i). EDUCATION BOARD KERALA BOARD OF PUBLIC EXAMINATIONS
(ii). ROLL NUMBER 193033
(iii). YEAR OF PASSING 2012
7a. GENDER MALE
8. LEVEL OF EDUCATIONAL QUALIFICATION GRADUATION
9. MOBILE NUMBER 9605998444
10. EMAIL ID shaijalkm35@gmail.com

ADDITIONAL DETAILS
11a. CATEGORY OBC
12. NATIONALITY CITIZEN OF INDIA
13. IDENTIFICATION MARKS A BLACK MOLE ON THE FOREHEAD
14a. ARE YOU A PERSON WITH DISABILITY? (40% OR NO
MORE)?

14b. TYPE OF DISABILITY -

14c. DISABILITY CERTIFICATE NUMBER -

14d. UPLOADED DISABILITY CERTIFICATE

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CONTACT DETAILS
15a. PERMANENT ADDRESS KOZHIMADAM HOUSE
PERHMANNA POST
15b. STATE/ UT KERALA
15c. DISTRICT KOZHIKODE
15d. PIN CODE 673019
16. IS PERMANENT ADDRESS SAME AS PRESENT YES
ADDRESS?

17a. PRESENT ADDRESS KOZHIMADAM HOUSE

PERHMANNA POST
17b. STATE/ UT KERALA

17c. DISTRICT KOZHIKODE

17d. PIN CODE 673019
18. CONTACT DETAILS FOR OTHER NATIONALS -

PHOTO, SIGNATURE AND BIOMETRIC IMPRESSION

19. UPLOADED PHOTO

20. UPLOADED SIGNATURE

21. UPLOADED LEFT HAND THUMB IMPRESSION (LTI)/

BIOMETRIC IMPRESSION

22. IF LTI IS NOT AVAILABLE DUE TO DISABILITY,

BIOMETRIC IMPRESSION OF RIGHT THUMB
IMPRESSION/LEFT GREAT TOE/RIGHT GREAT TOE

NOTE
THIS IS A DRAFT VIEW OF YOUR REGISTRATION.REGISTRATION PROCESS IS NOT YET COMPLETE.YOU
NEED TO DO 'FINAL SUBMIT' WITHIN 7 (SEVEN) DAYS OF GENERATION OF YOUR REGISTRATION NUMBER,
FAILING WHICH, YOUR REGISTRATION DATA WILL GET DELETED AUTOMATICALLY.

DRAFT PRINT TAKEN ON 13/02/2019 4:04:09 PM

DRAFT PRINT TAKEN ON 13/02/2019 4:04:09 PM