Application No. : 116/916087 Roll No. : EYP/CH/B/116/11399 (1) Name of the post applied for : Yantrik Technical (Electrical) (2) Centre allotted by Coast Guard for written test :- COAST GUARD DIST HQS NO-5 GM PETTAI ROAD, ROYAPURAM, CHENNAI- 600013 Date and Time of Reporting at Centre : 10 Oct 2015 Time 12:00:00 Choice of Centre(s) you have opted for appearing Test :- Priority Centre Name Full Address of the Centre Affix recent passport size THE COMMANDER, COAST GUARD colour Photo DIST. HEADQUARTERS NO.6(AP),PO VISHAKAPATNAM 1 BOX NO.1128 , MALKAPURAM PO, - VZ VISHAKAPATNAM, ANDHRA PRADESH -530011 (3) Name of the candidate (as in Matriculation) REDDI SATEESH Gender : Male (4) Current postal address: CHINANANDAPALLI(VILLAGE,POST) DEVARAPALLI(MANDALAM), CITY: VISAKAPATANAM, STATE: ANDHRA PRADESH, DISTRICT : VISAKHAPATNAM, PIN : 531030 (5) Permanent address: CHINANANDAPALLI(VILLAGE,POST) DEVARAPALLI(MANDALAM), CITY: VISAKAPATANAM, STATE: ANDHRA PRADESH, DISTRICT : VISAKHAPATNAM, PIN : 531030 (6) E-mail ID : sateeshreddi5@gmail.com (7) Mobile No : +918885931159 (8) Father's name : R.APPARAO (9) Category : OBC (10) Date of Birth : 12 Jul 1994 (11) Nationality : Indian (12) Qualification : Compl. Compl. Year of Qualification Board/Institution AggrPercent Subject Mark Passing Diploma 74.11 --NA-- 0 0 (13) Knowledge of Swimming : YES (14) Proficiency in sports, National Level (attach photocopies of certificate) : NO (15) NCC 'C' certificate- Grade obtained (attach photocopy of certificate, if yes) : --NA-- (16) Marital Status : Unmarried (17) Declaration : I, hearby solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief. I fully understand
that in the event of any information being found false or incorrect, appropriate action can be taken against me. NOTE: Candidates should bring domicile certificate as per the permanent address mentioned in the application form. Candidates without domicile certificate will not be allowed to sit in the examination. {FOR NAVIK(GD) ONLY} Place : VISAKAPATNAM Signature : Name of the Applicant : Date : 09/08/2015 REDDI SATEESH Print