"AF*.

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Date: 17.04.2023
To,
The Joint Director General
Archaeological Survey of India
Pt. DUIA
Greater Noida - 2013 10

l)-1\ma't;on U/
Sub: Pemissien foi appearing in SSC CGL Exam 2023-reg.

Sir,

With regard, I would like to inform you that, I wish to appear in the SSC CGL Exam
2023. So, I kindly request you to given -. ff5ffi to appearing in SSC CGL Exam 2023.

Thanking You, 1/
Yours Faithfully

laya lnstitute ;,r>

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 STAFF SELECTION COMMISSION
BLOCKNO. 12, CGO-COMPLEX, LODHI ROAD,
NEWDELHI .IlOOO3 ry <
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COMBINED GRADUATE LEVEL EXAMINATION, . ,'1.
2023 'tt
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REGISTRATION NO: 8500025b1 I 0

APPLICATION RECEIVED (CoNTENTS NOT VE

AS PER 2 3. FA' ,S
NAME
€P
4_ 'S NAME

DA,TE OF B IRTH (DDIMM/YYYY) 6. AGE AS ON

0t/08/2023 8. CATEGORY
10/08/ 1992 30.1 1
MALE ST
9. WHETHER PERSON WITH BENCHMARK
DISABILITY
(PWBD) ? 9.1 IF YES, TYPE OF DISABILITY HH,VH, OTHERS)

K OF VISIBLE I TION
MARK ON
l3 TION ( loth
NO
OF SECO (CBSE) 640s852 2008
OF EXAMINATION CENTER S
EXAMINATION CENTER EXAMINATION CENTER
EXAMINATION CENTER
(THIRD
l) JAIPUR ) UDAIPUR
16. ARE AN EX. 16.2. OFJOINING 16.3. OF LIKELY
SER OR SERVING DATE FROMARMED
THE FORCES? FORCES YYYY)
NO

I6.4. LENGTH OF SERVICE IN THE I 6.5. HA

YOU A LREA DY JOIN ED CIVI L
ARMED FORCES POST BY A' AILING BENEF' IT OF I6.5. DATE OF JOINING TO CIVIL POST
RESERVA TION FOR EX-SER VICEM, AN (DD/MM/YYYY)
M) ?
 I7. I. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?

I7.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATECORY OF OH.BOTH ARMS
AFFECTED ) oR oH- CEREBRAL PALSY (OH-CP)'I

I7.3. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AS PER PARA 7.2 OR PARA 7.3 OF THE NOTICE (CERTIFICATE
THIS EFFECT FROM COMPETENT AUTHORITY AS PER FORMAT AT ANNEXURE-VANNEXURE-IA TO THE NOTICE OF
EXAMINATION, BE AT THE TIME OF EXAMINATION)?
NO
17.4. WHETHER SCRIBE rS REQUIRED ? I7.5. WILL YOU MAKE YOUR OWN I7.6. IF SCRIBE IS TO BE ARRANGED BY
ARBANGEMENT OF SCRIBE ? SSC, INDICATE MEDIUM

YOU APPLYING FOR THE JUNIOR I8.2. DO YOU POSSESS EQ FOR THE POST OF JUNIOR
STATISTICAL OFFICER (MoSP STATISTICAL OFFICER (MoSPI)?
YES YES
I 9. I APPLYING FOR THE POST OF
. ARE YOU ALSO I9.2. DO YOU POSSESS EQ FOR THE POST OF STATISTICAL
STATISTICAL INVESTIGATOR GRADE OFFICER (RGI)? INVESTIGATOR GRADE OFI.'ICER (RGI)?
YES YES
20.I. WHETHER SEEKING AGE RELAXATION ? 20.2. IF YES, AGE RELAXATION CODE
YES O I.SC/ST
2I. HIGHEST EDUCATIONAL QUALIFICATION
B. rECH (14)
22- DETAILS OF TIONAL ALIFICATION
GRADUATION
STATE/UT OF
NAME OF
STATUS PASSING YEAR BOARD/ ROLL NO PERCENTAGE CGPA
BOARD/ UNIVERSITY
UNIVERSITY
DELHI TECHNOLOGICAL
PASSED 2014 DELHI 2K l0/ME/071 57.98
UNIVERSITY
23. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
OF DoP&T'S O.M NO.39020/l/20 l6-ESTT DATED 21.06.20t6 '-l
YES
ETAIL
PONDENCE ADDR 25. PERMANENT ADDRESS
33K AREA SECTOR 4 COLE MARKET 33K DIZ AREA SECTOR 4

DISTRICT: NEW DELHI DISTRICT:NEW DELHI

STATE: DELHI STATE: DELHI
PIN : I 10001 PIN : I 10001
MOBILE NO: 9958939197 EMAIL: mithlesh 100892(rlgmail.com
27. WHETHERTHE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 3-JANUARY.2O23'I
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED
 DECLARATION
TION THE OF THE

AND
OF ANY

THE IS CANCELLED.I

I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
THE

USE FOR
IP