7/21/2015

LEKHPALBHARTI2015

ApplicationForm

PersonalDetails
ApplicationNumber:

105318321

PostAppliedFor:

LEKHPAL/

DistrictAppliedFor(
):

GAZIPUR

NameofTheCandidate(
):

UTSAVSINHA

Father'sName(

):

CHANDESHWARPRASADSINHA

Mother'sName(

):

RANJUSINHA

DateofBirth():

23/07/1992

Age:

22

AgeMonths:

11

AgeDays:

Gender(
):

Male

Nationality():

Indian

Religion(
):

Hindu

MaritalStatus(
):

Single

UPDomicile(UP):

No

AppliedinCategory(
):

General

SkilledPlayerofUP(

?):

No

Gov/ExGovStateEmpofUP(
,

,00

No

?):

CorrespondenceAddress
AddressLine1(
1):

OPPOSITEITICOLLEGE

AddressLine2(
2):

BAGMUSA

AddressLine3(
3):

HAJIPUR

District():

vaishali

State():

Bihar

Pincode():

844101

MobileNo(
):

7258060198

EmailID(
):

utsav7023@gmail.com

AlternateMobileNo(

):

9608238076

PermanentAddress
PermanentAddress1(
1):

OPPOSITEITICOLLEGE

PermanentAddress2(
2):

BAGMUSA

PermanentAddress3(
3):

HAJIPUR

PermanentAddressDistrict():

vaishali

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7/21/2015

LEKHPALBHARTI2015
PermanentAddressState():

Bihar

PermanentAddressPincode():

844101

PermanentAddressMobileno(
):

7258060198

PermanentAddressemail(
):

utsav7023@gmail.com

QualifyingExaminationDetails
Examination
()

YearofPassing
(

Board/School
(
)

RollNumber
(.)

Percentage/Grade(
/
)

10thorEquivalentExamination

2008

cbse

5144545

83

12thIntermediate

2010

cbse

5651355

76

DoyouhaveanyadditionalQualification?

?:
Haveyouservedinterritorialarmyforminimumperiodof2years?

?:

Haveyouobtained'B'CertificateofNationalCadetCorps?

?:

No
No

No

ExaminationcenterDistrictPreferences(
)
Examinationcenterdistrict1(
1):

VARANASI

Examinationcenterdistrict2(
2):

MIRZAPUR

Examinationcenterdistrict3(
3):

CHANDAULI

FeeDetail
FeeApplicable(

):

300

AmountPaid(
):

300

TransactionId(

):

DU27454129

Dateoffeesubmission(
):

20/07/2015

Declaration
ISOLEMNLYUNDERTAKEtoacceptandabidebythenotification/rulesoftheBoardofRevenue,U.PIherebysolemnlyaffirmthatIhavegonethroughthe
Advertisement&Instructionsandsolemnlydeclareonoaththattheentriesmadebymeintheabovecolumnsaretruetothebestofmyknowledgeandbeliefandif
atanytime,theentriesarefoundincorrect,therecruitmentmayoutrightlybecancelledandsuitableactionmaybeinitiatedagainstme.Iwouldnothaveany
objection.
(
/

/
|

|)

Date:21/07/2015

CandidateSignature
Version10.00.01

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