Application of Job: UNIVERSITY ENTRY SCHEME

Application No: UES186M001131 Application Date: 11/07/2017

1. PRIORITY

4. SSC [SSC(IT_U)]
1. PC [PC{GS(X)_U}] 06/2018 2. SSC [SSC{GS(X)_U}] 06/2018 3. SSC [SSC{ATC_U}] 06/2018
06/2018

2. PERSONAL PARTICULARS

Name: BHANU PRATAP Nationality: INDIAN

Father's/Mother's Name: PANKAJ KHUSWAH Gender: MALE
Date of Birth: 11/10/1995 Guardian's Name: PANKAJ KHUSWAH
Identication Mark 1: MOLE AT NECK Aadhaar/Enrolment No.: 719729072464
Identication Mark 2: ---------

3. EDUCATION PARTICULARS

Details of Stream: COMPUTER Qualication Type:

Qualication:B.TECH SCIENCE REGULAR

Semesters Total Marks Obtained Marks

Semester 1 750 594

Semester 2 850 643

Semester 3 750 511

Semester 4 800 565

Semester 5 800 638

Grand Total 3950 2951

Percentage 74.71

Year of
Passing:2018
University Name: College
PUNJAB TECHNICAL Name:CHANDIGARH College
College State:PUNJAB
UNIVERSITY, ENGINEERING District:MOHALI
JALANDHAR COLLEGEE

Details of 12th Qualication

Percentage based 90.33%

12th English 10th English
Subjects Physics Chemistry Maths on PCM marks:
Marks Marks

Total Marks 100 100 100 100 100

Marks Obtained 86 90 95 84 95
 State Conducted
Serial no. of Board Conducted
Exam:UTTAR
Marksheet:814975 Exam:CBSE
PRADESH

Details of 10th Qualication

State Conducted Percentage in

Board Conducted Serial no. of
Exam:UTTAR 10th:91.2%:Grades
Exam:CBSE Marksheet:0553974
PRADESH in 10th:9.6

4. MILITARY RECORD

Have you ever been

enrolled in Armed Forces
before?: NO

Have you attended any Services Service type:Air force

Selection Board (SSB) before?: YES Type of entry:NDA

Have you been

discharged from Armed
forces before?: NO
5. COMMUNICATION PARTICULARS

Details of Permanent Address Details of Correspondence Address

Address 1: FLAT NO 901 9TH FLOOR BLOCK D8 Pincode: 140603 Same as Permanent Address
Address 2: MAYA GARDEN CITY DELHI CHANDIGARH
Mobile No.: 8146256927
HIGHWAY ZIRAKPUR
State: PUNJAB Email id: pratapbhanu636@gmail.com
District: MOHALI

A. 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.

B. 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.

C. I fully understand that in the event of my information being found false or incorrect, appropriate action can be taken against me.

D. Eligibility criteria will be veried on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can
be initiated against me for fraudulent entry and falsication of Government of India documents. I also accept that no TA/ DA will be
admissible to me in such cases.

6. APPLICATION FORM TO BE SIGNED BY THE DIRECTOR OF ENGINEERING COLLEGE/HEAD OF DEPARTMENT

Certied that Miss/Mr .............. is studying in this University/College/Institute and that details furnished by him in para 3 and
4 of application form have been checked with refrence to relevant records and found correct.
Place:........... Date:................ Signature(Director/HOD):..............................

CAMPUS VENUE DETAILS (TO BE FILLED IN BY THE APPLICANT)

DATE: COLLEGE VENUE: SIGN:

FOR OFFICE USE ONLY

GRADE: SIGNATURE: