STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI
110003
CONSTABLES (GD) IN CENTRAL ARMED POLICE FORCES
(CAPFs), SSF AND RIFLEMAN (GD) IN ASSAM RIFLES
EXAMINATION 2024
REGISTRATION NO: 40007078697
APPLICATION RECEIVED (CONTENTS NOT VERIFIED)
1. NAME AS PER MATRICULATION 2. NEW/CHANGED
3. FATHER'S NAME 4. MOTHER'S NAME
CERTIFICATE NAME
RULAMIN MONDAL - KOUSHAR MONDAL SAJEDA MONDAL
5. DATE OF BIRTH (DD/MM/YYYY) 6. AGE AS ON 01/01/2024 7. GENDER 8. CATEGORY
14/03/2002 21.9 MALE OBC
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA MOLE ON RIGHT MIDDLE HAND NEAR ELBOW
12. MATRICULATION (10th 13. MATRICULATION (10th
11. MATRICULATION (10th CLASS) EXAMINATION BOARD
CLASS) ROLL NO CLASS) YEAR OF PASSING
WEST BENGAL BOARD OF SECONDARY EDUCATION 400231N-0079 2019
14.1. WHETHER YOU ARE AN EX-SERVICEMEN (ESM) OR
14.2. DATE OF JOINING THE ARMED FORCES (DD/MM/YYYY)
SERVING IN THE ARMED FORCES?
NO -
14.3. DATE OF DISCHARGE FROM ARMED FORCES
14.4. LENGTH OF SERVICE IN THE ARMED FORCES
(DD/MM/YYYY)
- -
14.5. HAVE YOU ALREADY JOINED A CIVIL POST BY
AVAILING BENEFIT OF RESERVATION FOR EX-SERVICEMEN 14.6. DATE OF JOINING TO CIVIL POST (DD/MM/YYYY)
(ESM) ?
- -
15.1. WHETHER SEEKING AGE RELAXATION? 15.2 IF YES, AGE RELAXATION CODE
NO -
16.1. ARE YOU A NATIONAL CADET CORPS (NCC)
16.2. TYPE OF THE NCC CERTIFICATE
CERTIFICATE HOLDER
NO -
17. PREFERENCE OF EXAMINATION CENTRES
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
( FIRST PREFERENCE ) ( SECOND PREFERENCE) ( THIRD PREFERENCE)
KOLKATA ( 4410 ) BURDWAN ( 4404 ) KALYANI ( 4419 )
18. MEDIUM FOR COMPUTER BASED 19. STATE/ UT OF DOMICILE 20. DISTRICT OF DOMICILE
EXAMINATION (CBE)
BENGALI WEST BENGAL BANKURA
21.1. HAVE YOU MIGRATED FROM THE STATE/ UT OF 21.2. WHETHER YOU WOULD LIKE TO AVAIL THE BENEFIT OF
YOUR ORIGIN TO ANOTHER STATE/ UT RESERVATION FROM THE STATE/ UT OF YOUR ORIGIN
NO -
21.3. STATE/ UT OF ORIGIN 21.4. DISTRICT OF ORIGIN
- -
22. CANDIDATE BELONGS TO MILITANCY/ NAXAL
23. CANDIDATE BELONGS TO BORDER DISTRICT
AFFECTED DISTRICT
NO NO
24. PREFERENCE OF POST FOR CAPF(S)/ ORGANIZATION(S)
B,C,F,H,D,A,E,
25. HIGHEST EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
26. DETAILS OF QUALIFYING EDUCATION
10TH STANDARD
STATUS PASSING STATE/ UT OF BOARD/ NAME OF BOARD/ ROLL NO PERCENTAGE CGPA
YEAR UNIVERSITY UNIVERSITY
PASSED 2019 WEST BENGAL WEST BENGAL BOARD 400231N-0079 36.86 -
OF SECONDARY
EDUCATION
27. 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
28. CORRESPONDENCE ADDRESS 29. PERMANENT ADDRESS
VILL - BALIGUMA PO - JIABANDI VILL - BALIGUMA PO - JIABANDI
DISTRICT: BANKURA DISTRICT: BANKURA
STATE: WEST BENGAL STATE: WEST BENGAL
PIN: 722164 PIN: 722164
MOBILE NO. : 8777512494 EMAIL ID: [email protected]
30. WHETHER PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 24-AUGUST-2023?
YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 IGAQQFJOP1 28/12/2023
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE NOTICE
OF THE EXAMINATION.
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 PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR AFTER
THE STIPULATED DATED.
4. I AGREE TO AUTHORIZE SSC TO USE MY AADHAR DATA FOR VERIFICATION PURPOSE.
PRINT TAKEN ON: 28/12/2023 10:23:54 PM IP ADDRESS: 112.79.59.207
