J&K SERVICES SELECTION BOARD

GOVERNMENT OF JAMMU & KASHMIR

APPLICANT ID: 7422460411 APPLICATION DATE: 2020-08-18

APPLIED APPLICATION FORM FOR THE POST OF ACCOUNTS ASSISTANT (PANCHAYAT)

ADVERTISEMENT NUMBER - 02 OF 2020

PERSONAL DETAILS

APPLICANT NAME MR AQIF MANZOOR SHAH GENDER MALE

FATHER'S NAME MANZOOR AHMAD SHAH MOTHER'S NAME RUHI JAN

DATE OF BIRTH 1994-04-20 AGE AS ON 01.01.2020 25

PHONE NUMBER 7889421233 EMAIL AQIF765@GMAIL.COM

WHETHER MARRIED NO WHETHER DOMICILE YES

DOMICILE DIVISION KASHMIR DOMICILE DISTRICT PULWAMA

WHETHER DOMICILE DOMICILE CERTIFICATE

NO -
CERTIFICATE ISSUED? NUMBER

DOMICILE CERTIFICATE ISSUE DOMICILE CERTIFICATE

- -
DATE ISSUING AUTHORITY

DOMICILE DISTRICT AS PER DOMICILE TEHSIL AS PER

- -
CERTIFICATE CERTIFICATE

PERMANENT ADDRESS

LOCALITY/MOHALLA/WARD
HOUSE NO./ROOM NO. 07 MALIKPORA
NUMBER

VILLAGE/TOWN/CITY PULWAMA PANCHAYAT

BLOCK PULWAMA TEHSIL PULWAMA

PULWAMA (KASHMIR
DISTRICT PINCODE 192301
DIVISION)

CORRESPONDENCE ADDRESS

LOCALITY/MOHALLA/WARD
HOUSE NO./ROOM NO. 07 MALIKPORA
NUMBER

VILLAGE/TOWN/CITY PULWAMA PANCHAYAT

BLOCK PULWAMA TEHSIL PULWAMA

PULWAMA (KASHMIR
DISTRICT PINCODE 192301
DIVISION)
CATEGORY OF APPLICANT

CATEGORY OM DATE OF ISSUE OF CATEGORY CERTIFICATE -

CATEGORY CERTIFICATE ISSUING AUTHORITY -

ARE YOU SPECIALLY ABLED PERSON (PH)? NO DISABILITY PERMANENT OR TEMPORARY? -

TYPE OF DISABILITY - PERCENTAGE OF DISABILITY -

DATE OF ISSUANCE OF PHYSICAL DISABILITY CERTIFICATE - ISSUING AUTHORITY -

ARE YOU AN EMPLOYEE OF J&K GOVERNMENT? NO CATEGORY -

DATE OF APPOINTMENT / ENGAGEMENT - SELECT DEPARTMENT -

OTHER DEPARTMENT - APPOINTING AUTHORITY -

ARE YOU AN EX-SERVICEMEN? NO DATE OF RETIREMENT/DISCHARGE -

PENSION PAYMENT ORDER (PPO) NUMBER - EX-SERVICEMEN CERTIFICATE NUMBER -

EX-SERVICEMEN CERTIFICATE ISSUE DATE -

PREFERENCES

PREFERENCE 1 - PULWAMA PREFERENCE 11 - -

PREFERENCE 2 - SHOPIAN PREFERENCE 12 - -
PREFERENCE 3 - BUDGAM PREFERENCE 13 - -
PREFERENCE 4 - ANANTNAG PREFERENCE 14 - -
PREFERENCE 5 - GANDERBAL PREFERENCE 15 - -
PREFERENCE 6 - KULGAM PREFERENCE 16 - -
PREFERENCE 7 - BARAMULLA PREFERENCE 17 - -
PREFERENCE 8 - BANDIPORA PREFERENCE 18 - -
PREFERENCE 9 - - PREFERENCE 19 - -
PREFERENCE 10 - - PREFERENCE 20 - -

PENDING CRIMINAL PROCEEDINGS, IF ANY

WHETHER ANY FIR HAS BEEN LODGED/REGISTERED AGAINST

NO FIR(S) DETAILS -
YOU?

WHETHER ANY PROSECUTION IS PENDING IN ANY COURT OF

NO
LAW AGAINST YOU?

WHETHER YOU HAVE BEEN CONVICTED BY ANY COURT OF WHETHER ANY PROSECUTION IS PENDING IN ANY
NO -
COMPETENT JURISDICTION IN ANY OFFENCE? COURT OF LAW AGAINST YOU?

WAS ANY COURT CASE BEEN FILED AGAINST YOU? NO DETAILS -

WHETHER ANY CHARGESHEET HAS BEEN FILED AGAINST YOU? NO DETAILS -

SECTION UNDER WHICH CHARGESHEET HAS

NATURE OF OFFENCE - -
BEEN FILED

WHETHER ANY DISCIPLINARY ACTION HAS BEEN INITIATED BY

GOVERNMENT/SEMI-GOVERNMENT ORGANISATIONS AGAINST NO DETAILS -
YOU?
QUALIFICATION DETAILS

QUALIFICATION BOARD / UNIVERSITY PERCENTAGE OF MARKS RESULT DATE / AWARD DATE

SSC/MATRIC JK STATE BOARD 78 2009-12-15
SSSC(12TH) JK STATE BOARD 61.4 2012-01-15
GRADUATION KASHMIR UNIVERSITY 52.5 2015-01-15
POST GRADUATION KASHMIR UNIVERSITY 67 2018-12-14
PHD - - -

OTHER DETAILS

DO YOU POSSESS THE PRESCRIBED EDUCATIONAL

QUALIFICATIONS AS PER THE ADVERTISEMENT / YES
NOTIFICATION?

CHOICE OF EXAMINATION CENTER AT KASHMIR

I HEREBY DECLARE THAT I HAVE CAREFULLY READ THE ADVERTISEMENT NOTIFICATION FOR THIS
POST AND ALL THE TERMS AND CONDITIONS INDICATED THEREIN AND UNDERTAKE TO ABIDE BY THE
TERMS AND CONDITIONS OF THE ADVERTISEMENT / NOTIFICATION FOR PARTICIPATING IN THE
SELECTION PROCESS. I FULFILL ALL THE TERMS AND CONDITIONS MENTIONED IN THE
ADVERTISEMENT NOTIFICATION AND THE INFORMATION PROVIDED BY ME HEREIN IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO UNDERTAKE THAT IN CASE OF FAILURE TO
POSSESS THE QUALIFICATION PRESCRIBED IN THE ADVERTISEMENT NOTIFICATION, THE BOARD WILL
BE FULLY COMPETENT TO DEBAR ME FROM THE SELECTION PROCESS. I FURTHER STIPULATE THAT I
HAVE CAREFULLY READ THE GOVERNMENT NOTIFICATION AND ASSURE THAT I AM NOT BARRED BY
THE PROVISIONS OF THE SAID NOTIFICATION. I FURTHER UNDERTAKE THAT I SHALL NOT CLAIM ANY
BENEFIT OF ANY QUALIFICATION/CATEGORY THAT HAVE NOT SPECIFICALLY INDICATED IN THIS
ONLINE APPLICATION FORM. FURTHER, I AM AWARE THAT I WILL BE LIABLE FOR APPROPRIATE
PENAL ACTION, DISQUALIFICATION FROM THE SELECTION PROCESS OR LOSS OF THE JOB IN THE
EVENT OF SELECTION HAVING BEEN MADE, IF THE INFORMATION PROVIDED BY ME IS PROVED TO BE
INCORRECT AT ANY STAGE. THE CHARGES FOR FILLING UP THE FORM ARE RS.350 AND ARE NON-
REFUNDABLE. I AM AWARE THAT I SHALL NOT HAVE CLAIM OVER THE CHARGES, ONCE
SUCCESSFULLY PAID TO J&K SERVICES SELECTION BOARD, J&K.