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Application Form for TGC-119

1. Roll No. 2. Post Applied For 3. Candidate's Name 4. Father's Name 5. Mother's Name 6. Date of Birth 7. Nationality 8. Marital Status 9. Gender 10. Mobile No. 11. Email Address 12. Permanent Address

552954 TGC-119 ANURAG DEEPAK P SINGH SONA DEVI 05/11/1992 INDIAN Unmarried Male 8800754794 anu007dee@gmail.com

To Be attested by Gazetted Officer

13. Correspondance Address


14. SSB History: SNo.




15. Educational Details: 15(a) Education Qualification 15(b) Branch/Stream of Engineering 15(c) Date of Joining Engineering College 15(d) Date of completion of Degree 15(e) College Name 15(f) University Name 15(g) State in which University Located 15(h) Gate Score 15(i) Valid Upto 15(j) Is Diploma Subject
Physics Chemistry

B.Tech. Mechanical 08/17/2010 06/10/2014 MAHARAA AGRASEN INSTITUTE OF TECHNOLOGY GGSIPU Delhi 0.00 No

Total Marks
100 100

Obtained Marks
67 76

67.00 76.00

Maths/Biology Cumulative Percentage

100 61.33



1 2 3 4 5 6
Declaration :-

Total Marks
1200 1200 1000 1100 1100 1000

Obtained Marks
772 784 701 746 761 744

64.33 65.33 70.10 67.82 69.18 74.40

Cumulative Percentage
64.33 64.83 66.59 66.89 67.35 68.53

I affirm that all information supplied by me as above is true and correct, I also fully understand that if at any stage, it is discoverd that any attempt has been made by me to willfully conceal or misrepresent that facts, my candidature may be summarily rejected or employment terminated.

Signature of the candidate Place & Date : Your Registration Date & Time:12/13/2013 5:41:13 PM Your Application Submission Date & Time:12/13/2013 5:53:14 PM

Note :1. 2. 3.
The universities which have Grade Point system, need to convert Grades into %age of marks scored. Filling of cumulative %age of marks scored based on the Cumulative Grade at the end of third year/seventh semester/fourth year (as applicable) is compulsory; failing which the application will be rejected. For Candidates having only first year exams and not giving semester exams- Divide your first year marks in two equal halves and fill in 1st and 2nd semester. eg. 700/1000 is to filled as 350/500 and 350/500. Certificates attached with application form :(a) (b) (c)

Declaration :1. 2. 3. 4. 5. 6. 7.
I have read and understood the instructions and undertake to abide by them. I hereby declare that all statements made in the application are correct and true. I undertake not to have any objections in the event of my final selection on allotment of any Arms/Service in the interest of the organisation. I have never been debarred from appearing in any examination or UPSC and nor have I been arrested or convicted by a criminal court or involved in any other case registered by Police. I undertake not to make any claim or compensation if at any stage of selection, my ineligibility is detected and my candidature is cancelled as a result thereof. This is the only application submitted for Army Educations Corps (TGC-119) course and any duplicate application if detected at any stage, my candidature be cancelled. Any misinterpretation and wrong declaration/ concealment of information in the application will render my candidature to be cancelled and I may be debarred from this course. I have never been withdrawn from NDA, IMA or OTA or any service training academy on disciplinary grounds.

8. 9. I am employed with ________________________ & I have informed my employer in writing that I am applying for commission in the Army. 10. In the eventuality of being recommended by SSB I will have no objection to be medically examined by board of Male/Female doctors, provided a
lady medical officer is present (applicable only to lady cadets) 11. I undertake to be debarred & my candidature be cancelled, if at any stage of selection I indulge in any violation of local orders concerning discipline aspects. 12. I undertake not to marry till I complete the full training at the training academy, in case inducted. I also understand that in case of my final selection, my appointment will be provisional subject to satisfactory police and educational verification. 13. In case of resignation from Academy, cost of training will be paid by me.

14. This application is accepted provisionally subject to meeting eligibility criteria.