STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
SUB-INSPECTOR IN DELHI POLICE AND CENTRAL
ARMED POLICE FORCES EXAMINATION,
2023
REGISTRATION NO: 92000732211
APPLICATION RECEIVED (CONTENTS NOT VERIFIED)
1. NAME AS PER 2. NEW/ CHANGED NAME 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION
CERTIFICATE
MANISH KUMAR CHAUHAN - SURESH PRASAD CHAUHAN KALPANA DEVI
5. DATE OF BIRTH
6. AGE AS ON 01/08/2023 7. GENDER 8. CATEGORY
(DD/MM/YYYY)
26/03/2001 22.4 MALE OBC
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA BLACK MARK ON RIGHT SHOULDER
11. MATRICULATION (10th CLASS) EXAMINATION 12. MATRICULATION (10th CLASS) 13. MATRICULATION (10th
BOARD ROLL NO CLASS) YEAR OF PASSING
CENTRAL BOARD OF SECONDARY EDUCATION (CBSE) 7134651 2016
14. DO YOU BELONG TO CASTES NOT INCLUDED IN CENTRAL LIST OF OBCs BUT NOTIFIED AS OBC BY THE GOVT OF NCT
OF DELHI (SUCH CANDIDATES WILL BE CONSIDERED AS OBC FOR DELHI POILICE AND UR FOR OTHER POSTS)?
NO
15. DO YOU BELONG TO CASTES NOT INCLUDED IN CENTRAL LIST OF OBCs BUT NOTIFIED AS OBC BY THE GOVT OF NCT
OF DELHI (SUCH CANDIDATES WILL BE CONSIDERED AS OBC FOR DELHI POILICE AND EWS FOR OTHER POSTS)?
NO
16. ARE YOU A DEPARTMENTAL CANDIDATE OF DELHI POLICE ?
NO
17.1. ARE YOU A NATIONAL CADET CORPS (NCC) CERTIFICATE HOLDER ? 17.2. TYPE OF CERTIFICATE
NO -
18. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE ) (SECOND PREFERENCE) (THIRD PREFERENCE)
GUWAHATI (DISPUR) ( 5105 ) IMPHAL ( 5501 ) SILCHAR ( 5111 )
19.1.WHETHER YOU ARE AN EX- 19.2 DATE OF JOINING THE ARMED 19.3. DATE OF DISCHARGE/ LIKELY DATE OF
SERVICEMAN (ESM) OR SERVING FORCES (DD/MM/YYYY) DISCHARGE FROM ARMED FORCES
IN THE ARMED FORCES? (DD/MM/YYYY)
NO - -
19.5. HAVE YOU ALREADY JOINED A 19.6. DATE OF JOINING TO CIVIL POST
19.4. LENGTH OF SERVICE IN CIVIL POST BY AVAILING BENEFIT OF (DD/MM/YYYY)
ARMED FORCES RESERVATION FOR EX-SERVICEMAN
(ESM) ?
- - -
20. WHETHER ELIGIBLE FOR SPECIAL QUOTA AS ESM FOR DELHI POLICE?
21.1. WHETHER SEEKING AGE RELAXATION ? 21.2. IF YES,AGE RELAXATION CODE
NO -
22. HIGHEST EDUCATIONAL QUALIFICATION
BA (HONS.)(6)
23. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
GRADUATION
STATUS PASSING YEAR STATE/ UT OF NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
BOARD/ UNIVERSITY
UNIVERSITY
PASSED 2023 DELHI INDIRA GANDHI NATIONAL 187791616 55.5 -
OPEN UNIVERSITY
24. 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
25. CORRESPONDENCE ADDRESS 26. PERMANENT ADDRESS
AT BHERIYA RAHIKA WARD NO 02 PO BMP 07 KATIHAR AT BHERIYA RAHIKA WARD NO 02 PO BMP 07 KATIHAR
DISTRICT: KATIHAR DISTRICT:KATIHAR
STATE: BIHAR STATE: BIHAR
PIN : 854105 PIN : 854105
MOBILE NO: 6209740103 EMAIL:
[email protected] 28. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 23-April-2023?
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 CPACYJMMH2 29/07/2023
DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS MENTIONED
THEREIN.
2. 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.I AM WILLING
TO SERVE ANYWHERE IN INDIA.
3. I DECLARE THAT THE PHOTGRAPH UPLOADED IN APPLICATION FORM IS NOT MORE THAN 3 MONTHS OLD.
4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAAR DATA FOR VERIFICATION PURPOSE.
VERIFICATION WILL BE SUBJECT TO AUTHORIZATION FROM COMPETENT AUTHORITY.
PRINT TAKEN ON: 29/07/2023 5:24:02 PM IP ADDRESS: 157.35.88.35
NUMBER OF ATTEMPT: 1
