STAFF SELECTION COMMISSION

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

110003
Sub-Inspector in Delhi Police, CAPFs and Assistant Sub-
Inspector in CISF Examination, 2019

REGISTRATION NO: 83000341609

APPLICATION IS INCOMPLETE
1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION NAME
CERTIFICATE

NIKHIL SINGH - NAND KUMAR SINGH SUSHEELA SINGH

5. DATE OF BIRTH
6. AGE AS ON 01/01/2020 7. GENDER 8. CATEGORY
(DD/MM/YYYY)
05/03/1997 22.9 MALE UNRESERVED
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA CUT MARK UNDER CHIN
11. MATRICULATION (10th CLASS) EXAMINATION 12. MATRICULATION (10th 13. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
CENTRAL BOARD OF SECONDARY EDUCATION
5201263 2012
(CBSE)
15. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ?
NO
16. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
LUCKNOW ( 3010 ) KANPUR ( 3009 ) PRAYAGRAJ ( 3003 )
17.WHETHER EX- 17.1. HAVE YOU ALREADY 17.2. LENGTH OF SERVICE 17.3. DATE OF DISCHARGE
SERVICEMAN (ESM)? JOINED A CIVIL POST BY IN ARMED FORCES ( IN FROM ARMED FORCES
AVAILING BENEFIT OF YEARS ) (DD/MM/YYYY)
RESERVATION FOR EX-
SERVICEMAN (ESM) ?

NO - - -

18. WHETHER ELIGIBLE FOR SPECIAL QUOTA AS ESM FOR 19. WHETHER DEPARTMENTAL CANDIDATE OF DELHI
DELHI POLICE ? POLICE ?

- NO
 20.1 IF YES,INDICATE CODE
20. WHETHER SEEKING AGE RELAXATION ?

NO
-
21. QUALIFICATION DETAILS 22. 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 ?
B. TECH (14) YES

ADDRESS DETAIL
23. POSTAL ADDRESS 24. PERMANENT ADDRESS
Q.NO-852 TYPE-2 GC CRPF CAMPUS BIJNAUR LUCKNOW Q.NO-852 TYPE-2 GC CRPF CAMPUS BIJNAUR LUCKNOW

DISTRICT: LUCKNOW DISTRICT:LUCKNOW

STATE: UTTAR PRADESH STATE: UTTAR PRADESH
PIN : 226010 PIN : 226010
MOBILE NO: 9779188802 EMAIL: ursnikhilsingh@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 - -
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 the 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 false or incorrect at any stage or not satisfying the
eligibility criteria according to the Notice of Examination, my candidature/ appointment is liable to be cancelled/ terminated.
PRINT TAKEN ON: 26/09/2019 12:46:56 AM