2/2/23, 12:59 PM IB Form

Applicant Details HelpDesk

Personal Details

Application Sequence No
IB220253277

Candidate's Name
ANSHUMAN SHUKLA

Father's Name Mother's Name

SHAMBHU SARAN SHUKLA URMILA SHUKLA

Marital Status
Unmarried

Post Applied Details

Post Applied Post Code

Security Assistant/Executive 01

Domicile State/Union Territory Subsidiary Intelligence Bureau/SIB

Uttar Pradesh Lucknow

City Choice 1 City Choice 2

Bareilly Lucknow

City Choice 3 City Choice 4

Gorakhpur Noida

City Choice 5 Category

New Delhi EWS

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Gender Date of Birth (DD/MM/YYYY) same as Matriculation/

Secondary Certificate
Male
27/Jul/1998

Age as on 17.02.2023

24 Years 6 Months 21 Days Are you Physically Handicapped (PH) (degree of

disability 40% or above)?

No

Are you an Ex-Service man? Are you a government servant (departmental

candidate)?
No
No

Are you a Dependent of victims of 2002 riot in Gujarat Are you a Dependent of victims of Anti-Sikh riots of
? 1984?

No No

Do you have domicile certificate for the SIB you are

Are you a sportsperson specified in Para 1 (a) of D.o.P. applying to ?
& A.R., O.M. No. 14015/1/76-Estt.(D), dated 4.8.1980 ? Yes
No

Contact Details

Mobile Number

7080718771 Email ID

anshumanshukla.27jul@gmail.com

Present Address

Address Line 1
House no.2 Balaji nagar

Address Line 2
Near new government hospital azizganj shahjahanpur

Country
India

State City
Uttar Pradesh Shahjahanpur

Pin Code
Is Permanent Address same as Present Address?

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242001 Yes

Permanent Address

Address Line 1

House no.2 Balaji nagar

Address Line 2

Near new government hospital azizganj shahjahanpur

Country
India

State City
Uttar Pradesh Shahjahanpur

Pin Code

242001

Matriculation (10th) Details

Name of the Board/Council

Board of higher secondary education uttar pradesh

Institute Name

Sanjay Kumar saraswati vidya mandir

Subject Combination

Hindi, English,maths, science, social science, Sanskrit

Year Of Passing Grading Pattern

2013 Percentage

Percentage of Marks

77.66

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Intermediate (12th) Details

Name of the Board/Council

Board of higher secondary education Uttar Pradesh

Subject Combination
Hindi, English,maths, physics and chemistry

Institute Name
Sanjay Kumar Saraswati vidya mandir

Year Of Passing Grading Pattern

2015 Percentage

Percentage of Marks
69.2

Language Proficiency Details

Local Language/Dialect that you are proficient in.

Hindi

Work Experience Details

Do you have field experience in Intelligence work?

No

Payment Details

Amount Payment Mode

500 online

Payment Status Payment Transaction No.

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Successful CPACLEDKY4

Candidate Documents/Images Upload Details

Photograph Signature

Declaration

I hereby, solemnly declare that information provided by me in the form is true to the best of my
knowledge and belief. I understand that my candidature is subject to the conditions laid down in
the advertisement brochure. I further declare that I am not involved in any criminal case and/or no
such case is pending against me in any court of law.

Version 15.00.01

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