RTG DTE 6

Additional Directorate
General for Recruiting
INDIAN ARMY
ONLINE APPLICATION FORM FOR NON UPSC ENTRIES
COURSE SER NO TGC - 113 , SS (Tech) - 37 

1.Entry TGC , SS (Tech) 2.Sex Male photo

3.Nationality Indian 4.Marital Status Unmarried  

5.Roll No. 507590      

6.(a) Candidate's ASHUTOSH KUMAR

Full Name

   (b) Father's Full PRABHUNATH SINGH

Name

7. Date of Birth 30 Dec 1989      

8. Educational Appearing 9.Ward of battle casuality/widow   --NA--

Qualification BE/BTech

10. Previous Attempt(s) at SSB :

--
NA--

11. TES Entry :

Percentage of Marks in Only 10+2 in PCM  0.00

--
NA--

12. For TGC SST and SSW(T) Entry :

Date of completion of 01 Jun 2011
degree/Completion of final
exam, as entered by
applicant online
College Name SKYLINE INSTITUTE OF ENGINEERING AND
TECHNELOGY
University Name UTTAR PRADESH TECHNICAL UNIVERSITY
State in which University Uttar Pradesh
Located  
13. For JAG Entry Aggregate % of marks obtained in LLB :
Eligibile for enrolment as --NA--
advocate in BAR Council ?
14. For AEC & MF(TGC Entry) :
Branch / Subject --NA--
15. For Engineering Branch SSCW(T),SSC(T),UES & TGC :
Engineering Branch Mechanical (incl Industrial/Industrial Engg
(Management))

16. Permanent Addr: b13 phase 4 raptinagar City : gorakhpur District : GORAKHPUR
Address State : Uttar Pradesh Pin 273409 Tele(Mobile) 9311024566

      Current Addr: sanjay singh a 138 second floor sector 22 Noida District :
Address  GAUTAM BUDDHA NAGAR State : Uttar Pradesh Pin : 201301
Tele(Mobile) : 9311024566

      E-mail ID ashutosh_singh773@yahoo.com

17. Declaration :

1. I have read and understood the instructions and undertake to abide by them.

2. I hereby declare that all statements made in the application are correct and true.

3. 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 organistion.

4. I have never been debarred from appearing in any examination or UPSC and nor have I
been arrested or convicted by a criminal court or involved in any other case registered by
police.

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 result thereof.

6. This is the only application submitted for this course any duplicate application if
detected, my candidature be cancelled.

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.

8. I have never been withdrawn from NDA, IMA or OTA or any servic training academy on
displinary grounds.

9. I am employed with _____________ & I have informed my employer in writing that I

am applying for commission in the Army.

10. In the eventuality of being recommeded by SSB I will have no objection to be medically
examined by board of Male/Female doctors, provided a lady medical officer is present
(applicable only to lady cadets).

11. I undertake to be debarred & my candidature be cancelled, if at any stage of selection I

indulge in any violation of local orders concerning discipline aspects.

12. I undertake to join any other parallel entry i.e. from TGC/UES to SSC (T), subject to
availability of vacancies and agree to the terms and conditions of that entry. (Applicable to
TGC and UES entries only.)

13. 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 police and educational verification.

14.(a) In case of resignation from Academy, cost of training will be paid by me.

     (b) Candidates are requested to take a print out, paste his/her photograph in the space
provided and send it alongwith attested copies of the required certificate to this office by
post. Candidates are also required to carry one more ink-signed copy of the
Acknowledgement without fail alongwith the photograph pasted on it, original certificate
and a valid proof of identity to the Selection Centre when called for the interview.

15. This application is accepted provisionally subject to meeting eligibility criteria.

Do you accept the terms and conditions mentioned above___________ Please write yes to
allow processing of your application

Place :    

Date :     Signature of
Applicant
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