STAFF SELECTION COMMISSION
BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI
110003
JUNIOR ENGINEER (CIVIL, MECHANICAL,
ELECTRICAL AND QUANTITY SURVEYING &
CONTRACTS) EXAMINATION 2019
REGISTRATION NO: 30000576824
APPLICATION IS INCOMPLETE
1. NAME AS PER
MATRICULATION
CERTIFICATE
2. NEW/CHANGED
NAME
3. FATHER'S NAME
4. MOTHER'S NAME
VISHAL KUMAR MALL
-
MAKSUDAN MALL
VIMLA MALL
5. DATE OF BIRTH (DD/MM/YYYY)
6. AGE AS ON 01-01-2020
7. GENDER
10/02/1992
27.1
MALE
8. CATEGORY
9. NATIONALITY
10. MARK OF VISIBLE
IDENTIFICATION
OBC
CITIZEN OF INDIA
DARK MOLE ON RIGHT
CHEEK
11. MATRICULATION (10th CLASS) EXAMINATION
BOARD
12. MATRICULATION (10th
CLASS) ROLL NO
13. MATRICULATION (10th
CLASS) YEAR OF PASSING
BOARD OF HIGH SCHOOL AND INTERMEDIATE
EDUCATION UTTAR PRADESH
2486385
2006
14. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST )
EXAMINATION CENTER ( SECOND )
EXAMINATION CENTER ( THIRD )
DELHI ( 2201 )
ROORKEE ( 2006 )
AJMER ( 2401 )
15.WHETHER EX-
SERVICEMAN (ESM)?
15.1. HAVE YOU ALREADY
JOINED A CIVIL POST BY
AVAILING BENEFIT OF
RESERVATION FOR EX-
SERVICEMAN (ESM) :?
15.2. LENGTH OF SERVICE IN
ARMED FORCES ( IN YEARS )
15.3. DATE OF DISCHARGE
FROM ARMED FORCES
(DD/MM/YYYY)
NO
-
-
-
16. WHETHER PERSON WITH DISABILITY
(PWD) ?
16.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO
-
17. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION)?
NO
17.1 WHETHER SCRIBE IS REQUIRED
17.2 WILL YOU MAKE YOUR OWN
ARRANGEMENT OF SCRIBE?
17.3 IF SCRIBE IS TO BE
ARRANGED BY SSC, INDICATE
MEDIUM
NO
-
-
18. WHETHER SEEKING AGE RELAXATION?
18.1 IF YES,INDICATE CODE
NO
-
