2/8/24, 4:12 PM Updated Application Form 2300601144

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BIHAR STAFF SELECTION COMMISSION

P.O.-VETERINARY COLLEGE, PATNA - 800014
ADVERTISEMENT NO. 02/2023
SECOND INTER LEVEL COMBINED COMPETITIVE EXAM-2023
PERSONAL DETAILS
REGISTRATION NO.: 2300601144
FORM NO. : 3300601144
NAME OF APPLICANT : PRAVEEN KUMAR SRIVASTAWA
FATHER'S NAME : RAMBABU SRIVASTAWA
MOTHER'S NAME : SANGITA DEVI
GENDER : MALE
MOBILE NO. : 7461879315
EMAIL ID : PRAVEENKUMARSRIVASTAWA55@GMAIL.COM
DATE OF BIRTH : 06-09-2001 LIVE PHOTO

AGE AS ON 01-08-2023 : 21 YEARS, 10 MONTHS, 26 DAYS

NATIONALITY : INDIAN
CATEGORY : GEN
DO YOU BELONG TO EWS? : YES
(EBC/BC-NCLC CERTIFICATE NUMBER) / (SC/ST-CASTE
EWSCO/2023/667133
CERTIFICATE NUMBER) / (EWS-CERTIFICATE NUMBER) :
ISSUE DATE OF CERTIFICATE : 25-10-2023
CERTIFICATE ISSUING AUTHORITY : RO
DOMICILE OF BIHAR STATE : YES
ISSUE DATE OF DOMICILE CERTIFICATE: 31-10-2023 PHOTO

ISSUE NUMBER OF DOMICILE CERTIFICATE : BRCCO/2023/11310983

DOMICILE CERTIFICATE ISSUING OTHER COMPETENT
RO
AUTHORITY :
SIGNATURE IN ENGLISH
ARE YOU PERSON WITH DISABILITY? : NO

SIGNATURE IN HINDI

DO YOU HAVE AADHAR CARD? : YES (AADHAR CARD NUMBER: 391226026634)

ID PROOF : AADHAAR CARD ID PROOF NO : 391226026634
BIHAR GOVERNMENT EMPLOYEE WHO HAS RENDERED NOT LESS THAN 3 YEARS
NO
REGULAR AND CONTINUOUS SERVICE? :
WHICH ATTEMPT IS OF INTER LEVEL EXAMINATION? : 01
IDENTIFICATION MARK OF THE CANDIDATE : A MOLE ON LEFT SIDE OF NOSE
ARE YOU AN EX-SERVICEMAN? : NO
WARD OF FREEDOM FIGHTER? : NO
HAVE YOU EVER BEEN DEBARRED FROM ANY COMPETITIVE EXAMINATION
NO
(UPSC/BOARD/STATE COMMISSION/ANY OTHER)? :
WORKED/WORKING AS CONTRACTUAL EMPLOYEE IN BIHAR GOVERNMENT: NO
ADDRESS DETAILS

CORRESPONDENCE ADDRESS PERMANENT ADDRESS

VILL - KISHUNBARI , PO - CHAINPUR , PS VILL - KISHUNBARI , PO - CHAINPUR , PS
ADDRESS: ADDRESS:
- SISWAN , DIST - SIWAN - SISWAN , DIST - SIWAN

VILLAGE/MOHALLA: KISHUNBARI VILLAGE/MOHALLA: KISHUNBARI

POST OFFICE: CHAINPUR POST OFFICE: CHAINPUR
POLICE STATION: SISWAN POLICE STATION: SISWAN

DISTRICT: SIWAN DISTRICT: SIWAN

STATE: BIHAR STATE: BIHAR
PIN CODE: 841203 PIN CODE: 841203
EDUCATIONAL QUALIFICATIONS
EDUCATION SUBJECT BOARD / TOTAL MARKS PERCENTAGE PASSINGDATE CERTIFICATE
UNIVERSITY / MARKS OBTAINED NUMBER
INSTITUTE
10TH / EQUIVALENT ALL SUBJECT BSEB 500 365 73.00 22-06-2017 171011606247
12TH / EQUIVALENT PHYSICS
12TH/INTERMEDIATE CHEMISTRY BSEB 500 378 75.60 30-03-2019 1030948
(SCIENCE) MATHS
TECHNICAL SKILL

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2/8/24, 4:12 PM Updated Application Form 2300601144
HAVE YOU DONE ANY COMPUTER COURSE? NO
PAYMENT DETAILS:
PAYMENT BANK : SBI
TRANSACTION ID : 2469151214820
TRANSACTION DATE : 2023-11-05 18:00:51
REGISTRATION FEE (RS.) : 540
VIEW UPLOADED 10TH MARKS SHEET PDF: CLICK HERE TO VIEW DOCUMENT
VIEW UPLOADED 10TH PASS CERTIFICATE PDF: CLICK HERE TO VIEW DOCUMENT
VIEW UPLOADED 12TH MARKS SHEET PDF: CLICK HERE TO VIEW DOCUMENT
VIEW UPLOADED 12TH PASS CERTIFICATE PDF: CLICK HERE TO VIEW DOCUMENT
VIEW UPLOADED VALID PHOTO ID PROOF PDF: CLICK HERE TO VIEW DOCUMENT
VIEW UPLOADED BIHAR DOMICILE CERTIFICATE PDF: CLICK HERE TO VIEW DOCUMENT
VIEW UPLOADED EWS CERTIFICATE PDF: CLICK HERE TO VIEW DOCUMENT
DECLARATION DETAILS:
I HEREBY DECLARE THAT THE FINAL INFORMATION FILLED UP ABOVE BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I
ALSO DECLARE THAT I HAVE FILLED UP ONLY ONE APPLICATION FORM. I ALSO UNDERTAKE THAT IF ANY INFORMATION IS FOUND
OTHERWISE, I SHALL BE LIABLE FOR ANY LEGAL ACTION AND CANCELLATION OF MY CANDIDATURE BY THE COMMISSION.
DATE : 08-02-2024 16:02:59
NOTE: PLEASE KEEP YOUR REGISTRATION NO.,PASSWORD,MOBILE NO AND EMAIL-ID CAREFULLY FOR FURTHER REFERENCE.

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