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CCC Exam Registration Guide

This document is a registration form for a CCC examination for government employees in Gujarat, India. It contains personal details of the applicant named Kumpavat Jaysinh Jitendrasinh, including date of birth, address, job details, and payment details. It also includes a declaration by the applicant confirming the accuracy of the information provided and understanding of examination rules.

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Jaysinh Kumpavat
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440 views2 pages

CCC Exam Registration Guide

This document is a registration form for a CCC examination for government employees in Gujarat, India. It contains personal details of the applicant named Kumpavat Jaysinh Jitendrasinh, including date of birth, address, job details, and payment details. It also includes a declaration by the applicant confirming the accuracy of the information provided and understanding of examination rules.

Uploaded by

Jaysinh Kumpavat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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3/16/2018 www.gujaratccc.co.in/Gujrat/Reports/RegistrationFormReport.

aspx

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CCC EXAMINATION FOR GOVERNMENT EMPLOYEE REGISTRATION FORM

Exam Seat No :

Application Form No : GUCCC18031000

Course Name : CCC - EXAMINATION

Personal Details
Full Name : KUMPAVAT JAYSINH JITENDRASINH

Date of Birth : 12/6/1994

Age : 23Y

Mobile : 9409544151

Gender : Male Female Transgender

Designation : JUNIOR TECHNICAL ASSISTANT

Aadhaar Card No. : 849026554160 GPF/CPF Account No. :

Marital Status : UNMARRIED Caste : GENERAL

Present Address : 16-A, PATEL SOCIETY,


NEAR HIGHWAY ROAD,
KHEDBRAHMA-383255,
SABARKANTHA,
GUJARAT.

Village Name : KHEDBRAHMA

District : SABARKANTHA Taluka : KHEDBRAHMA

State : GUJARAT Pincode : 383255

Whether Physically Handicapped? : Yes No

Are You Blind? : Yes No

Whether Ex-Servicemen? : Yes No

Whether Likely to be promoted higher scales within months? : 139

Date of Joining GOVT. Services : 13/10/2017

Date of Joining in Department : 13/10/2017

Date of Retirement : 30/6/2052

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Organizational Details

Exam Type : THEORY AND PRACTICAL

Name of Secretariat : LABOUR AND EMLOYMENT DEPARTMENT

Name of Department : LABOUR COMMISSIONER

Name of Institute : DEPUTY DIRECTOR OF BOILERS VADODARA

Institute/Of ice Address : ROOM NO-628,627,



BLOCK - I, KUBER BHAVAN,
KHOTHI KACHERI COMPOUND,
VADODARA-390001

Village Name : VADODARA Taluka : VADODARA

District: VADODARA State : GUJARAT

Pincode : 390001

Name & Designation of Head of institute/of ice : A A SHAH DEPUTY DIRECTOR OF BOILERS VADO

Contact No. of Head : 9909949289

Email Id of Head : [email protected]

Payment Details
Date : 16/03/2018 Transaction Number : eP1234210732
Amount : 200 Payment Type : Online

Documents :
AADHAAR CARD

PAN CARD

VOTER ID Voter ID No. NIC1759190

DRIVING LICENSE NO

Declaration
I declare that I have illed the application form after thoroughly understanding rules and the information illed by
me in the application form is correct and true to the best of my knowledge and belief.
I also understand that my application will be rejected if any of the information submitted in this form is found to
be incorrect / false.

TO WHOMSOEVER IT MAY CONCERN


This is to certify that the information given in this registration form for CCC examination is
veri ied and found to be correct as per the of ice records.
Signature of the Of icial Designation:

Please paste your latest photo duly stamped
Name of the Of icial : by your department head

Email address:

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