Application Registration No: 64002726768 for the Multi Tasking(Non - Technical) Staff In

Different States/ UTs, 2016

Your Application is Completed
1.& 1.1. Name of Center and Center
Code :

NR-Delhi(2201)
NR-Jaipur(2405)
NR-Dehradun(2002)

2.Candidate Name :

ABHISHEK SRIVASTAV

3.Father's Name :

DINESH SRIVASTAV

4.Mother's Name :

MAMTA SRIVASTAV

5.Date of Birth (dd/mm/yyyy) :

15/08/1998

6. Age(as on 01.08.2017) :

18.11

7. Nationality :

Indian

8.Gender :

Male

9.Category :

General

10. Whether PH (PWD) :

No

10. If yes, indicate code :

10.1. Whether Ex-Serviceman? :

No

10.2. For Ex-Serviceman-Length of

Service(in years) :
10.2. Date of discharge (dd/mm/yyyy) :
11. Whether seeking Age relaxation? :

No

11.1. If yes, indicate code :

12. Whether suffering from cerebral
palsy? :
12. If VH/Cerebal Palsy candidate,
whether scribe is required ?
13. if yes indicate medium :
14. Whether you belong to Religious
Minority Community ? :

No

15. Aadhar Card Number (If available):

16.Mark of Visible Identification :
17. State/UT Code :

FGHJ12345678ABCDEIKLMNPRSTUWXYZXX

18. Educational Qualification :

12th Pass

19. Details of Work Experience :

Name of the
organisation

Designatio
n

Nature of
Duty(ies)

Period of Service
From(mm/yyyy)

Period of Service
To(mm/yyyy)

20.Postal Address :

H NO 13-D GALI NO 10-A MOLARBAND

EXTN

Village/City :

BADARPUR

District :

SOUTH DELHI

State :

Delhi

Pincode :

110044

21.Permanent/Domicile Address :

H NO 13-D GALI NO 10A MOLARABND EXTN

BADARPUR

State :

Delhi

Pincode :

110044

STD Code :
Phone Number :
Mobile Number :

9810832711

Email ID :

abhisheksrivastava15898@gmail.com
22.Photo

23.Signature

Payment Details :
Transaction id :

IK00BOXYD7

Transaction Date(yyyy-mm-dd) :

2017-01-21

Amount :

100

Declaration
I hereby declare that all the 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 and after examination,
my candidature/appointment is liable to be cancelled.
Place:
Date (yyyy-mm-dd):2017-01-21
Signature of Candidate

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