Application Form

Personal Details

Application Number: 101550001

Post Applied For: LEKHPAL/

District Applied For( ): ALLAHABAD

Name of The Candidate( ): DILIP KUMAR

Father's Name( ): MOOL CHAND

Mother's Name( ): VIMLA DEVI

Date of Birth( ): 06/02/1995

Age: 20

Age Months: 4

Age Days: 26

Gender(): Male

Nationality( ): Indian

Religion(): Hindu

Marital Status( ): Single

UP Domicile(UP ): Yes

Applied in Category( ): SC

Skilled Player of UP( ?): No

Gov/Ex Gov State Emp of UP( ,

, 00

?):

No

Correspondence Address

Address Line 1( 1): VILL POST SIKANDER PUR BAJHA

District(): KAUSHAMBI

State(): Uttar Pradesh

Pincode( ): 212213

Mobile No( ): 8736800594

Email ID(): kumarshakyadilip@gmail.com

Alternate Mobile No( ): 7783899140

Permanent Address 1( 1): VILL POST SIKANDER PUR BAJHA

Permanent Address District(): KAUSHAMBI

Permanent Address State(): Uttar Pradesh

Permanent Address Pincode( ): 212213

Permanent Address Mobile no( ): 8736800594

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Permanent Address email(): kumarshakyadilip@gmail.com

Qualifying Examination Details

Examination()

Year of Passing( )

Board/School()

Roll Number( .)

Percentage/Grade(/ )

10th or Equivalent Examination 2011 U P Board 2070170 41.83

12th Intermediate 2013 U P Board 1466255 74.8

Do you have any additional Qualification? ?: No

Have you served in territorial army for minimum period of 2 years? ?:

No

Have you obtained 'B' Certificate of National Cadet Corps? ?:

No

Examination center District Preferences( )

Examination center district 1( -1): KAUSHAMBI

Examination center district 2( -2): ALLAHABAD

Examination center district 3( -3): PRATAPGARH

Fee Detail

Fee Applicable( ): 150

Amount Paid( ): 150

Transaction Id( ): DU24147183

Date of fee submission( ): 05/07/2015

Declaration

I SOLEMNLY UNDERTAKE to accept and abide by the notification/rules of the Board of Revenue, U.P I hereby solemnly affirm that I have gone through the

Advertisement & Instructions and solemnly declare on oath that the entries made by me in the above columns are true to the best of my knowledge and belief and if atany time, the entries are found incorrect, the recruitment may out rightly be cancelled and suitable action may be initiated against me. I would not have any objection.

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Date : 13/07/2015 Candidate Signature

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