STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
CONSTABLE (GD) IN CAPFs, NIA, SSF AND RIFLEMAN
(GD) IN ASSAM RIFLES EXAMINATION 2018

REGISTRATION NO :71000645113

APPLICATION IS PROVISIONALLY SUBMITTED

1. CANDIDATE'S NAME 2. FATHER'S NAME 3. MOTHER'S NAME
VELUGU VENKATESWARLU VELUGU VENKATA RAO VELUGU RATHAMMA
4. DATE OF BIRTH (DD/MM/YYYY) 5. AGE AS ON DATE (01/08/2018) 6. GENDER
25/04/1998 20.3 MALE
9. MARK OF VISIBLE
7. CATEGORY 8. NATIONALITY
IDENTIFICATION
A MOLE ON THE BACK
OBC CITIZEN OF INDIA
SIDE OF THE NECK
10. MATRICULATION (10th CLASS) 12. MATRICULATION (10th
11. MATRICULATION (10th CLASS) ROLL NO
EXAMINATION BOARD CLASS) YEAR OF PASSING
BOARD OF SECONDARY EDUCATION
1316132937 2013
ANDHRA PRADESH
13. PREFERENCE OF EXAMINATION CENTER
PREFERENCE OF EXAMINATION CENTER CODE PREFERENCE OF EXAMINATION CENTER
8601 HYDERABAD
8008 VIJAYWADA
8001 GUNTUR
14.WHETHER EX- 14.1. IF EXS, WHETHER 14.2. LENGTH OF SERVICE ( 14.3. DATE OF DISCHARGE
SERVICEMAN (ExS)? ELIGIBLE FOR IN YEARS )
RESERVATION?
NO - - -
15. WHETHER SEEKING AGE 15.1. IF YES,INDICATE CODE 16. STATE / UT OF 17. DISTRICT OF
RELAXATION? DOMICILE DOMICILE
NO ANDHRA PRADESH PRAKASAM
18. HAVE YOU MIGRATED FROM THE 18.1 WHETEHR YOU WOULD LIKE TO 18.2 WHETHER YOU WANT TO BE
STATE/ UT OF YOUR ORIGIN TO THE AVAIL RESERVATION FROM THE CONSIDERED AS A UR CANDIDATE
STATE/ UT WHERE YOUR CASTE IS STATE/ UT OF ORIGIN FROM THE STATE/ UT OF DOMICILE
NOT RECOGNISED AS SC/ ST/ OBC?
NO - -
18.3. STATE OF ORIGIN 18.4. DISTRICT OF ORIGIN 19. CANDIDATE BELONGS 20. CANDIDATE BELONGS
TO MILITANCY/ NAXAL TO BORDER DISTRICT
AFFECTED DISTRICT
- - NO NO

21. PREFERENCE OF POSTS FOR CAPF'S & ORGANISATIONS

GBHDFEAC
22. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
YES
23. EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2

ADDRESS DETAIL
24. POSTAL ADDRESS 25. PERMANENT ADDRESS
H.NO:2-00 ,PERAMGUDIPALLI VILLAGE H.NO:2-00 ,PERAMGUDIPALLI VILLAGE
KANIGIRI MANDAL KANIGIRI MANDAL

DISTRICT: PRAKASAM DISTRICT:PRAKASAM

STATE: ANDHRA PRADESH STATE: ANDHRA PRADESH
PINCODE: 523254 PINCODE: 523254
MOBILE NO: 7095057342 EMAIL: venki1998.25@gmail.com
SIGNATURE THUMB IMPRESSION

FEE AMOUNT TRANSACTION NO TRANSACTION DATE

NOT EXEMPTED 100 CPK0069486 23/09/2018
DECLARATION
I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF ANY
INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
PRINT TAKEN ON: 23/09/2018 8:10:44 PM