os12023, 13:37 PWD Application Form 2023 Candidate Photo Application Status Registration Application Number PaymentSuccess Number/atauft 1043653 wie EIPWD054737 Candidate's Name/ ‘Sagara ara ROHIT SANJAY MOTGHARE Date of Birth/a™ Gender/fit Have you ever Reate Male changed your 23/Apr/1997 name?/SeaT ATaTt Fae as BT No Marital Status/ Father's Name/ Mother's Name/ ‘aanfee aaftrer agate orga are Unmarried SANJAY KALAVATI Email ID/S-At Mobile Number/ Alternate Mobile rohitmotghare23@g Haga dae Number / afdt mail.com 8983688728 Atarga tae 9096058121 Post Details/Wararad Artec Apply Post/aerdt Name of Appointing —_Level / €i¥ Prast at Authority/Prgett State Junior Engineer (Civil) orftrepeorre} area ~ Group-B Non Public Works Gazetted Department, Govt. of Maharashtra Candidate Domicile and Category Details / Sgarerar egare sifor warfar mater Nationality /agtud Are youdomicile of |—_Reservation Caste Indian Maharashtra State?/ Category/SiaiUT wel renngr east SITGTa BT? Other Backward Class Yes (080) nitpsfg26tesion. com/EFormsiNewGenericAferPaymentActionClass.do?854892232704ZZonline 19os12023, 13:37 PWD Application Form 2023 Category in which you want to apply Other Backward Class (OBC) Category Certificate Details / Wa Watt WaroTaaral aap Caste Category Caste Category Certificate Issuing Certificate Issue Authority/ora wat Date/aa WaToTTa warorea ore eT ‘fecaren feria saree 05/12/2017 DEPUTY COLLECTOR Date of Issue of Certificate/Birth Domicile/sftrare certificate/School WATT / OH eRe leaving Issuing PRET SSCA Authority/siftrare areen Priftra way ore =| ear ae eer asco 13/06/2014 ‘araen Prfftra ‘wea wrateray wena DEPUTY COLLECTOR NAGPUR Identification Details/sr@etaraa THRE Any Do you have Pan Identification/birth Card?arrores TF marks you want to ‘ors sie or specifyz/amaurFYge Yes oe shard orci white sieaarr aw . NO Do you have Driving License?/sTTores ares areevarat WRAMT 378 BT? Yes Name on Driving Issuing Authority/ License Number/ are eure Re ROT aed arafavarear MAHARASHTRA, STATE MOTOR ‘Wear ware ROUT MOTCHARE DRIVING LICENCE Type of Driving License/TTaTT WTR Caste Category Certificate Serial No/@ira WHTOTATET wre 730297105122017/M RC-81/2017-2018 Certificate Details/Rare WaTOTTATAT TURRET Domicile Certificate Serial No/aiftrare WTO / OH aT 7B SSCA area arya 730918113062014/M RC-81/2013-2014 Pan Card Number/ wrod aa DEVPM1214N Name on Pan Card/ Ward alae ROHIT SANJAY MOTGHARE MH4920150000579 Date of Issue/aTet ‘eure fee 15/01/2015 Validity of Driving License: ‘deat 14/01/2035 nitpsfg26tesion. com/EFormsiNewGenericAferPaymentActionClass.do?854892232704ZZonline 29os12023, 13:37 PWD Application Form 2023 MCG/MCWG Do you have Voter 1d2/sTTOTS Prasye sews ame BT Account Holder Bank Name / aa Name / @rdureert ae are BANK OF ROHIT SANJAY MAHARASHTRA MOTGHARE Additional Details/sifafeaa TARE Are you a Are you a son/daughter of State/Central farmer who have Government committed suicide?/_ —_ Employee?/qrét qe snmgar TeaSy RES ae-are Aer @aard srera er? Aerh one or No No Are younominated Are you 1991 Census byFreedomfighter/ _Staff2/a1T01 1991 = yer wrote eat aimiferd et ae er? No No Are you a Part Time Employee 2/3110 aizrercis erent STENT BT? No Are you a family Are you an Eligible member of an ex- Sports Person (ESP)? serviceman who we sag died in service or (ESP) aiTeTa BT? was disabled dueto No Do you have Passport7/amqorees uramtd ae @1? No Do you have Bank Passbook? / qrones do mage ame Br Yes Account Number / Grd wae 25008632313 Are you Project Affected7/qrt VOTE STA BT? No Are you Earthquake Affected ?/ Get {OTR SETA BT? No Are you Post 1994 Election Staff?/3T70T @aex teed Frasier edad sirera er? No Are you an Ex Servicemen (ESM)2/ ent ate (ESM) SiTBTa 1? No Are you PWBD i.e. Person with Benchmark Disabilities with at least 40% disability2/qet Pwe teuret fear 40% artirea orereteht ‘aanrd ania ore SATETA BT? No nitpsfg26tesioncom/EFormsiNewGenericAferPaymentActionClass.do?854892Z327047Zonline a9os12023, 13:37 Non Creamy Layer/Ews Certificate Issuing Authority / aif #tt ‘AaVEWs WTA ond work watrereor DEPUTY COLLECTOR Do you want to apply under Orphan Category 2/ sa SPITE STBTA BT? No Have you ever been arrested /detained in any criminal case(s)?/qrere ‘@etél erorerét eI we sew J areara Yours iret 3g BT? No PWD Application Form 2023 Non Creamy Layer/EWs Certificate Issue Date / ata art AAREWS WTO ont award atte 04/11/2023 Are you debard from any previous Examination?/ sero ara etoreaT ubatardt wfereieiter we ag era? No Have you ever been tried & convicted or acquitted by a Court of Lawin any criminal case(s)?/ ‘whore wien Gera Grae wet ‘Gea aera Ae ang saftr atets ‘Perera oxaat ans frat Prafa ovat ame? No Non Creamy Layer/EWS Certificate Serial Number / =a ait ‘ceRveWs WATT syeHie 235054032128640108 7367 Whether any FIR or Criminal case(s) has ever been registered against your preaMrer watt ewaraaie fran wiorartt ween (wee Agen ter ome Br No Have you ever had to execute any bond for keeping peace/good behaviour under security proceedings of CrP C2PaTHTRR: wiwant after waem oda adupe Savarardt gare eth ator ‘aes ferga are ore ome BT No nitpsfg26tesioncom/EFormsiNewGenericAferPaymentActionClass.do?854892Z327047Zonline 49os12023, 13:37 PWD Application Form 2023 Have youeverbeen —_Are you facing any proceeded against criminal by any proceedings in any School/College/Univ court of Law in ersity in case of any India?/MreaTatet Unfair means ‘whoreét (UMC)or any sarererarae erent charges?/QHearae whaant orang ag, ote rey ame BT? erereray No frantormega wlorent arate ‘aug araa (uc) fran etorerét aero arate orearg wRUATE aire B18 BT No Address Line 2/78 ite 2 PLOT NO 88 B, SHIV NANDANVAN, NAGAR BEHIND AZAMSHAH HIGH SCHOOL Pincode/Postal Is Permanent Code/famisriket Address Same as as Correspondence 440009 address?/@TaHa Wea WaaraEe TRRARGTE 3i1 BT? Yes Permanent Address/@T7Hal ToT Address Line 2/751 ats 2 PLOT NO 88 B, SHIV NANDANVAN, NAGAR BEHIND AZAMSHAH HIGH SCHOOL Pincode/Postal Codes frets /ahect as 440009 Is there any departmental enquiry / court enquiry pending against you2/qyeut faves feuntta atest saranda atest welfare ame 1? No Country/@xr india StateRToT Maharashtra City/District/T%/ freer Nagpur Country / 3&0 India State / 16a Maharashtra City/ District/ 31e¢/ freer Nagpur nitpsfg26tesioncom/EFormsiNewGenericAferPaymentActionClass.do?854892Z327047Zonlineos12023, 13:37 PWD Application Form 2023 Qualification Details / Waa aaett Do you have Knowledge of Marathi language? Yes UGC Details Have you obtained Degree from UGC recongized University (Including Open University)? No Matriculation (10th) Details / Ate (10 dh auferet Name of the Passing _School/ Institute Percentage of Board/tarfores Name/aret / Heke Marks/CGPA/Grade deers ae ryt Maharashtra State Jyotiba Madhyamik cebartcarants Board Vidyaaya Percentage Marks Obtained / Maximum Marks / Percentage of Marks wea yor oredta area ToT (%) / Tore cava 413 550 (%) 75.09 Month & Year of Passing / Hig afgat nor sftof gtoard af 03/2012 Intermediate (12th) Details / 9 @t auaita, Name of the Passing School Institute Percentage / Marks Board/terforer Name /3et/ wet / Grades cRPATA deer aa ara Tord dofeitehie Maharashtra State Keshavnager Junior Percentage Board College Marks Obtained / wre oT 383 Maximum Marks / Percentage of Marks —_Year of Passing / rede area TT 1 Toh carat oat gear at 650 58.92 02/2014 Graduation Details/Ugdtar aueite, Qualification Degree —_Institute/Board/pas__ Month and Year of 1 Ura vedt sed from / Satoh Passing / Satof Degree in Civil ‘eden Geke aa: ‘erearen afer annfor Engineering at nitpsfg26tesioncom/EFormsiNewGenericAferPaymentActionClass.do?854892Z327047Zonline 69os12023, 13:37 PWD Application Form 2023 nitpsfg26tesioncom/EFormsiNewGenericAferPaymentActionClass.do?854892Z327047Zonline Rashtrasant Tukdoji 11/06/2018 Percentage of Maharaj University Marks/CGPA/Grade =P rypirst cabancaPats Percentage Marks Obtained / Maximum Marks / Percentage of Marks rea oT “rete area TOT rywidt cera 857 1350 63.48 Test City Preferences Test Center District Test Center District _Test Center District Preference 1/UgtaiT Preference 2/78taiT Preference 3/U8t&iT urenh ae fore ret | area Sa force ot | arachl x foreet ect a 2 3 Nagpur Chandrapur Amravati Payment Details / 2a quai Amount Payment Mode Payment Status 300 online Payment Success Payment Transaction Number 21C51515384332 Documents Upload / @MIqua aucits Set ‘Captured Photo Signature Document View/ Download To view your copy of scanned 10th class certificate: Click here. To view your copy of scanned 12th class certificate: Click here. To view your copy of Graduation degree certificate: Click here To view your copy of Domicile Certificate/Birth certificate/School leaving Certificate Click here, To view your copy of Caste Certificate: Click here To view your copy of Caste Validity Certificate: Click here. To view your copy of Non Creamy Layer/EWS Certificate: Click here. To view your copy of small family Certificate: Click here To view your copy of Pan Card: Click here. 79