Staff Selection Commission

Block No. 12, CGO-Complex, Lodhi Road, New Delhi 110003

Recruitment of Combined Graduate Level Examination, 2018
Registration No: 64016701916

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code

NR-Dehradun(2002) 2002
NR-Haridwar(2005) 2005
NR-Delhi(2201) 2201

Candidate's Full Name Father's Name Mother's Name Date of Birth

SACHIN GAUTAM GANGARAM RAJ DULARI 1998-08-16

Gender Nationality Fee Category

Male Indian Exemption claimed SC

Fee Option Amount Transaction-ID Transaction Date

Whether Ex-serviceman Length of Service (in years) Date of Discharge If ExS, Whether eligilble for
reservation
No

Whether If yes,type Do you Do you suffer from Locomotor Whether scribe is If yes,
Person with of suffer from Disability (40% or more) wherein the required in case of indicate
Disability disability(O Cerebral dominant writing extremity is affected VH/Cerebral medium
(PwD)? H,HH,VH,O Palsy (40% to the extent of slowing down the Palsy/Locomotor
thers) or more) ? performance? Disability (40% or
more)?
No

Age as on (01.08.2018) Whether seeking Age relaxation? Age Relaxation code

19.11 No

Are you also applying for the Do you possess EQ for the Whether belong to Minority Mark of visible identification
Post of Junior Statistical Post of Junior Statistical Communities as per Govt.
Officer ? Officer ? Orders?
No No No INJURY MARK ON FOREHEAD

Educational Qualification (Please note that possession of Graduate Qualification is a pre-requisite to apply for this
examination,However you may indicate your highest qualification)
B.Com.

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

Address Detail
Communication Address Permanent Address
H NO 6 6284 GHARI MALOOK NO 2 NEAR INDIAN OVERSEAS H NO 6 6284 GHARI MALOOK NO 2 NEW MADHO NAGAR
BANK NEW MADHO NAGAR SAHARANPUR NEAR INDIAN OVERSEAS BANK SAHARANPUR
City: SAHARANPUR State: Uttar Pradesh
District: SAHARANPUR Pin Code: 247001
State: Uttar Pradesh Mobile No.: 7417201700
Pin Code: 247001 Email Id: gautamsachin416@gmail.com
 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

Printed on:(mm/dd/yyyy): 06/03/2018 11:26:10