2/18/24, 2:36 PM Application Form

HIMACHAL PRADESH VIDHAN SABHA SECRETARIAT

Post Applied For :Clerk-10

Application No. 44931

1. Applicant's Name : NEHA

2. Guardian's Name: PAWAN KUMAR

3. Date of Birth(DD/MM/YYYY)in figures : 10/12/2001

4. Category : SC

5. Mobile No : 6230060663

6. Permanent Address : WARD NUMBER 1 VPO CHALET TEHSIL GHANARI CHALET UPPERLA 124 CHALET HIMACHAL
PRADESH

7. Address for correspondence : WARD NUMBER 1 VPO CHALET TEHSIL GHANARI CHALET UPPERLA 124 CHALET
HIMACHAL PRADESH

8. Academic Qualifications:
Sr Year of Percentage of Marks
Qualification Board/University from where passed
No. Passing obtained
Himachal Pradesh Board of School
1. Matric 2017 76.86
Education

9. Examination Fee Details:

Sr No. Reference Number Date of Deposit Amount
1. No Fees for Female 18/02/2024 0.00

DECLARATION
I hereby declare that I am an Indian National and the statements made in this application are true,complete and correct to the best of my knowledge and
belief.I undertake that in the event of any information found false or incorrect at any stage, my candidature shall be cancelled and if appointed, appointment
itself shall be cancelled. I also solemnly declare that I do not suffer from any of the disqualifications shown in the advertisement for the post and I am eligible in
all respects according to eligibility criteria prescribed therein.

Dated :- 18/02/2024
(Signature of Candidate)

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