APPLICATION FORM FOR Short Service Commission Executive{GS(Hydro)} JUN 16 BATCH

(UNMARRIED MALE/ FEMALE CANDIDATES ONLY)

FOR INDIAN NAVY OFFICE USE ONLY

Code No:

For Office use only:

Application No:
(Affix Photograph)

VALID / INVALID
SGX1630201318
1. CHOICE OF ENTRY : [3] SSC(NA)

[2] SSC{GS(X)}

[1] SSC{GS(Hydro)}

2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:

NAME:

niraj prasad

DATE OF BIRTH:

1994/08/25

FATHER'S NAME:

rajesh

FATHER'S OCCUPATION:

horticulture contractor

DOMICILE:

Maharashtra

GENDER:

Male

NCC:

No

BLOOD GROUP:
3.NATIONALITY:

INDIAN

4.MARITIAL STATUS: Unmarried

6. ADDRESS:

5.EMAIL: nrjprasad29@gmail.com

PERMANENT

PRESENT

bldg 7 flat 2 prakash colonysalisbury park gultekdi

bldg 7 flat 2 prakash colonysalisbury park gultekdi

DISTRICT

pune

pune

STATE

Maharashtra

Maharashtra

PINCODE

411037

411037

TELEPHONE --NA--

020-24271368

MOBILE

8793876332

--NA--

7. EDUCATION PARTICULARS:
Qualification

Stream

Year of Passing

Percentage

B.E

Civil Engineering

2015

72.11%

Maximum Marks

Marks Obtained

Maximum Marks

Marks Obtained

1st Semester

2nd Semester

1775

1479

3rd Semester

750

460

4th Semester

750

507

5th Semester

750

478

6th Semester

750

511

7th Semester

750

485

8th Semester

750

605

8. I HAVE NOT ATTENDED ANY SSB INTERVIEW TILL DATE

DECLARATION
1.I, hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never been
arrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police.
2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief.
3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.
4. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiated against me for fraudulent entry and falsification of GOI
documents. I also accept that no TA/DA will be admissible to me in such cases.
5. I have completed my B.E as on date.

NOTE:
Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ORDINARY POST
ONLY. You will be intimated via Email or SMS regarding your SSB Call-up, if shortlisted. Kindly check your Email inbox regularly.
Place ______________

Date _____________

September 7, 2015, 12:07 am

Signature of Applicant