1/5/2021 IB Form
Applicant Details
Personal Details
Application Sequence No
MHA141200250
Candidate's Name
DHEERAJ ASHOKRAO GHOTE
Father's Name Mother's Name
ASHOK SUREKHA
Marital Status Nationality
Unmarried A Citizen of India
Religion ID Proof
Hinduism Aadhar Card
Aadhar Number Home State
411503170048 Maharashtra
Post Applied Details
Exam City Choice 1
Post Applied Pune
Assistant Central Intelligence Officer- Grad
e II/Executive
Exam City Choice 2
Aurangabad(Maharashtra)
Exam City Choice 3 Category
Nanded EWS
Gender Date of Birth same as Matriculation/ Secondary
Certificate
Male
15/Aug/1996
Age as on 09.01.2021 Are you an Ex-Service man?
No
https://www.digialm.com/EForms/SBINewAfterPaymentAction.do?68961ZZ1258ZZonline 1/5
1/5/2021 IB Form
24 Years 4 Months 25 Days
Are you a Departmental Candidate who have
rendered 3 years of regular & continuous service in
central government ?
No
Were you originally domiciled in the state of Jammu Are you a dependent of victim of communal riot of
and Kashmir between 01.01.1980 and 31.12.1989 as 2002 in Gujrat?
well as the children?
No
No
Are you a Sportsperson?
No
Contact Details
Mobile Number
8408822772 Email ID
[email protected]
Present Address
Address Line 1
santai nivas narayan nagar ausa road latur
Address Line 2
near zhulelal temple
Country
India
State City
Maharashtra Latur
Pin Code
413512
Permanent Address
Address Line 1
santai nivas narayan nagar ausa road latur
https://www.digialm.com/EForms/SBINewAfterPaymentAction.do?68961ZZ1258ZZonline 2/5
1/5/2021 IB Form
Address Line 2
near zhulelal temple
Country
India
State City
Maharashtra Latur
Pin Code
413512
Matriculation (10th) Details
Name of the Board/Council
maharashta state board of secondary and higher secondary education
Year Of Passing
2012 Institute Name
shree deshikendra vidyalaya latur
Percentage of Marks
Subject Combination 82
marathi sanskrit english math science soci
al science
Certificate Number
S121730350
Course Type
R(Regular)
10+2 Details/Diploma Details
Select Option
Diploma
Name of the Board/Council
MSBTE
https://www.digialm.com/EForms/SBINewAfterPaymentAction.do?68961ZZ1258ZZonline 3/5
1/5/2021 IB Form
Year Of Passing Institute Name
2015 VAPM ALMALA
Percentage of Marks
Subject Combination 72.73
MANAGEMENT TESTING POWER ELECTRONI
CS ILLUMINATIN TRACTION PROJECT SCESSI
Certificate Number
ONAL WORK
1015189
Course Type Whether this institute is recognised by the
state/central government ?
R(Regular)
Yes
Essential Qualification Details
Qualification Name
Graduation or Equivalent from recognized university
Specialization
ELECTRICAL Institute Name
JSPM WAGHOLI
Year Of Passing Percentage of Marks
2018 61.06
Certificate Number Course Type
B120732525 R(Regular)
Desirable Qualification
Do you have Knowledge of Computers ?
Yes
Payment Details
Amount Payment Status
600 Successful
https://www.digialm.com/EForms/SBINewAfterPaymentAction.do?68961ZZ1258ZZonline 4/5
1/5/2021 IB Form
Payment Transaction No.
CPAANPHQG7
Candidate Photo and Signature Upload Details
Photo
Signature
Declaration
I hereby, solemnly declare that the information given above is true and correct to the best of my
knowledge and I fulfil the eligibility conditions laid down in the detailed advertisement, for
appearing in the recruitment test conducted by Ministry of Home Affairs for the post of Assistant
Central Intelligence Officer Grade-II/Executive. I further declare that in case any of the above
information is found to be false/incorrect or any information is found to be suppressed or any
ineligibility being detected before, during or after the recruitment process, my candidature for this
post is liable to be forfeited. I further declare that I am not involved in any criminal case and/or no
such case is pending against me in the court of law.
Version 13.09.00
https://www.digialm.com/EForms/SBINewAfterPaymentAction.do?68961ZZ1258ZZonline 5/5
