Government of India

Staff Selection Commission

Print Form
STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003

Combined Higher Secondary Level (10+2) Examination 2025

REGISTRATION NO: 10023555532

Application Completed(Contents Not Verified)

1. CANDIDATE'S NAME (AS PER THE MATRICULATION CERTIFICATE) 2. NEW/ CHANGED NAME 3. GENDER 4. CATEGORY
MAMTA - Female SC
7. DATE OF BIRTH (DD/MM/YYYY)
5. FATHER'S NAME 6. MOTHER'S NAME
(AS PER THE MATRICULATION CERTIFICATE)
BIJENDER SUSHILA 25/02/1998

8. AGE AS ON 01/01/2026 9. NATIONALITY 10. VISIBLE IDENTIFICATION MARK

27 Years 10 Months 8 Days Citizen of India MOLE ON CHIN

11. WHETHER A PERSON WITH BENCHMARK DISABILITY (PwBD) ? 11.1. IFYES, TYPE OF DISABILITY (OH, HH, VH, OTHERS)
No -
12. MATRICULATION (10th CLASS) EXAMINATION BOARD 13. MATRICULATION (10th CLASS) YEAR OF PASSING 14. MATRICULATION (10th CLASS) ROLL NO.

Central Board of Secondary Education (CBSE) 2014 8721921

ADDRESS DETAILS

15.1 CORRESPONDENCE ADDRESS 16.1 PERMANENTADDRESS

HOUSE NO 29 POLE NO 25D NEAR BALMIKI MOHALLA HOUSE NO 29 POLE NO 25D NEAR BALMIKI MOHALLA
15.2. STATE: Delhi 16.2. STATE: Delhi

15.3. DISTRICT: West Delhi 16.3. DISTRICT: West Delhi

15.4. PIN: 110041 16.4. PIN: 110041

17. EMAIL [email protected] 18. MOBILE NUMBER 7678174228

19. HIGHEST EDUCATIONAL QUALIFICATION

Higher Secondary (10+2)

20. DETAILS OF QUALIFYING EDUCATIONAL QUALIFICATION
20.1. EQ STATUS 20.2. PASSING YEAR 20.3. STATE/ UT of BOARD/ UNIVERSITY

Passed 2016 Delhi

20.4. NAME OF BOARD/ UNIVERSITY

CENTRAL BOARD OF SECONDARY EDUCATION (CBSE)

20.5. ROLL NUMBER 20.6. PERCENTAGE 20.7. CGPA

9699674 57.33

21. WHETHER YOU ARE AN EX-SERVICEMAN (ESM) OR SERVING IN THE ARMED FORCES? 21.1 DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)

No -

21.2. DATE OF DISCHARGE FROM ARMED FORCES (DD/MM/YYYY)? 21.3. LENGTH OF SERVICE IN ARMED FORCES
- -

21.4. HAVE YOU ALREADY JOINED A CIVIL POST BYAVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMAN (ESM) ? 21.5. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
No -

22. WHETHER SEEKING AGE RELAXATION ? 22.1. IFYES, AGE RELAXATION CODE

Yes 01 - SC/ST

23. DO YOU WANT TO MAKE YOUR PERSONAL INFORMATION AVAILABLE FOR ACCESSING JOB OPPORTUNITIES IN TERMS OF DOP&T'S OM NO.39020/1/2016-ESTT.(P) DATED 21/06/2016?

Yes

24. PREFERENCE OF EXAMINATION CENTER

24.1. EXAMINATION CENTER (FIRST PREFERENCE ) 24.2. EXAMINATION CENTER (SECOND PREFERENCE ) 24.3. EXAMINATION CENTER (THIRD PREFERENCE )
NR-Delhi (2201) CR-Agra (3001) NR-Dehradun (2002)

25. MEDIUM FOR COMPUTER BASED EXAMINATION (CBE): 26. MEDIUM FOR TYPING TEST:

01 - Hindi English

27.1. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF BLINDNESS (VH)?

No
27.2. ARE YOU A PERSON WITH BENCHMARK DISABILITIES (40% OR MORE) IN THE CATEGORY OF OH-BOTH ARMS AFFECTED (OH-BA) OR OH-CEREBRAL PALCY (OH-CP)?

No
27.3. DO YOU HAVE PHYSICAL LIMITATION TO WRITE AS PER PARA 7.2 OR 7.3 OF THE NOTICE?
(CERTIFICATE TO THIS EFFECT FROM COMPETENTATHORITYAS PER FORMATATANNEXURE-1/ANNEXURE-1ATO THE NOTICE OF EXAMINATION, WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?

No
27.4. WHETHER SCRIBE IS REQUIRED?
 No

27.5. WILLYOU MAKE YOUR ARRANGEMENT OF SCRIBE?

No

27.6. IF SCRIBE IS TO BE ARRANGED BY SSC, THEN INDICATE MEDIUM?

28. WHETHER 12TH STANDARD PASS IN SCIENCE STREAM WITH MATHEMATICS AS A SUBJECT FROM A RECOGNISED BOARD OR EQUIVALENT?
(FOR DEOs IN DEPARTMENT/MINISTRY MENTIONED AT PARA 8.1 OF THE NOTICE)

Yes
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE

EXEMPTED - - -
 DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPTALL THE TERMS & CONDITIONS MENTIONED THEREIN.

2. I HEREBY DECLARE THATALL 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 AGREE TO AUTHORIZE SSC TO USE MYAADHAAR DATA FOR VERIFICATION PURPOSE.

PRINT TAKEN ON: 25-06-2025 10:11 AM

NUMBER OF ATTEMPT: 1

(Signature)

IP ADDRESS:

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