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    Print Application Form Go To SSC Online Application Home Page

    Uploaded by

    JR Saravanan
    This document is an application registration for the Combined Higher Secondary Level Examination in 2016. It provides details about the applicant such as name, father's name, date of birth, gender, nationality, category, address, contact information, and educational qualification. The applicant is seeking age relaxation and fee exemption as an OBC candidate with a physical disability and has applied for the post of PLDEC with English as the medium for the typing test. Photos and signatures of the applicant are also included.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Print Application Form Go To SSC Online Application Home Page

    Uploaded by

    JR Saravanan
    214 views1 page
    This document is an application registration for the Combined Higher Secondary Level Examination in 2016. It provides details about the applicant such as name, father's name, date of birth, gender, nationality, category, address, contact information, and educational qualification. The applicant is seeking age relaxation and fee exemption as an OBC candidate with a physical disability and has applied for the post of PLDEC with English as the medium for the typing test. Photos and signatures of the applicant are also included.

    Original Description:

    SSC

    Original Title

    SSC Application

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    © © All Rights Reserved

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    This document is an application registration for the Combined Higher Secondary Level Examination in 2016. It provides details about the applicant such as name, father's name, date of birth, gender, nationality, category, address, contact information, and educational qualification. The applicant is seeking age relaxation and fee exemption as an OBC candidate with a physical disability and has applied for the post of PLDEC with English as the medium for the typing test. Photos and signatures of the applicant are also included.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    214 views1 page

    Print Application Form Go To SSC Online Application Home Page

    Uploaded by

    JR Saravanan
    This document is an application registration for the Combined Higher Secondary Level Examination in 2016. It provides details about the applicant such as name, father's name, date of birth, gender, nationality, category, address, contact information, and educational qualification. The applicant is seeking age relaxation and fee exemption as an OBC candidate with a physical disability and has applied for the post of PLDEC with English as the medium for the typing test. Photos and signatures of the applicant are also included.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Page 1 of 1

    Application Registration No: 63007180049 for the Combined Higher Secondary Level Examination - 2016
    Your Application is Completed
    1.& 2. Name of Computer Based written Examination Center and Code :
    SR-Tiruchirapalli(8206)
    SR-Chennai(8201)
    SR-Madurai(8204)
    3.Candidate Name :
    R SARAVANAN
    4.Father's Name :
    K RATHINAM
    5.Mother's Name :
    R JAGADAMBAL
    6.Date of Birth (dd/mm/yyyy) :
    23/05/1981
    7.Gender :
    Male
    8. Nationality :
    Indian
    9.Fee Exemption claimed :
    Exemption Claimed
    10.Category :
    OBC
    10.1.Whether Ex-Serviceman? :
    No
    10.2. For Ex-Serviceman-Length of Service(in years) :
    10.2. Date of discharge (dd/mm/yyyy) :
    10.3. Whether eligible for Ex-Serviceman Reservation? :
    11. Whether PH (PWD) :
    Yes
    11.1. If yes, indicate code :
    OH
    11.2. Whether suffering from cerebral palsy? :
    No
    11.2. If VH/Cerebal Palsy candidate, whether scribe is required ?
    11.3. if yes indicate medium :
    12. Whether seeking Age relaxation? :
    Yes
    12. If yes, indicate code :
    04-PH+OBC
    12.1. Age(as on 01.01.2017) :
    35.7
    13. Preference for posts :
    PLDEC
    14. Indicate medium for Typing Test :
    English
    14.1. Do you possess knowledge of Typing Test ? :
    Yes
    15. Aadhar Card Number (If available):
    16.Mark of Visible Identification :
    ASM OVER THE RIGHT CHEST
    17. Whether you belong to Religious Minority Community ? :
    No
    18. Educational Qualification :
    MBA
    19. Do you want to make available your personal Information for the accessing job opportunity in terms of DoP
    Yes
    & T's O.M.No. 39020/1/2016-Estt.(B) dated 21.06.2016 ? :
    20.Postal Address :
    4/19 KUDI STREET
    Village/City :
    VISVAMBAL SAMUTHIRAM SOUTH POST THURAIYUR T
    District :
    TRICHY
    State :
    Tamil Nadu
    Pincode :
    621003
    4/19 KUDI STREET VISVAMBAL SAMUTHIRAM SOUTH P
    21.Permanent Address :
    THURAIYUR TK TRICHY DT
    State :
    Tamil Nadu
    Pincode :
    621003
    STD Code :
    Phone Number :
    Mobile Number :
    9535599553
    Email ID :
    jrsarav@gmail.com
    23.Photo
    24.Signature

    Declaration

    I hereby declare that all the 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 and after examination, my candidature/appointment is liable to be cancelled.
    Place:
    Date (yyyy-mm-dd):2016-11-10
    Signature of Candidate

    Print Application Form


    Go to SSC Online Application Home Page

    http://164.100.129.99/chsl/pdfprint/verifyprint.jsp

    11/10/2016

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