Applicationform
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PGD1630403116 APPLICATION FORM FOR Permanent Commission (PC) Education Jun16 BATCH (Affix Photograph) (UNMARRIED CANDIDATES ONLY) FOR INDIAN NAVY OFFICE USE ONLY Code No: For Office use only: Application No: VALID / INVALID 1. CHOICE OF ENTRY : [2] SSC(LOG) [1] PC(EDU) 2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE: NAME: MOHAN KUMAR JHA DATE OF BIRTH: 1993/01/12 FATHER'S NAME: UDAY KANT JHA FATHER'S OCCUPATION: PRIVATE JOB DOMICILE: Bihar GENDER: Male 3.NATIONALITY: INDIAN 4.MARITIAL STATUS: Unmarried 5.EMAIL: [email protected] 6. ADDRESS: PERMANENT PRESENT VILL-MAHNAPO-MAHNA VILL-MAHNAPO-MAHNA DISTRICT BEGUSARAI BEGUSARAI STATE Bihar Bihar PINCODE 851210 851210 TELEPHONE --NA-- 06243-265570 MOBILE --NA-- 9973467214 7. EDUCATION PARTICULARS: Qualification Stream Year of Passing Percentage B.Tech Electronics and Communication 2014 77.35% Maximum Marks Marks Obtained Maximum Marks Marks Obtained 1st Semester 1000 715 2nd Semester 1000 782 3rd Semester 1000 762 4th Semester 1000 748 5th Semester 1000 809 6th Semester 1000 771 7th Semester 1000 786 8th Semester 1000 815 8. I HAVE NOT ATTENDED ANY SSB INTERVIEW TILL DATE 9. Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and obtain NOC from the present employer.) : NA DECLARATION 1.I, hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never been arrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police. 2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief. 3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me. 4. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiated against me for fraudulent entry and falsification of GOI documents. I also accept that no TA/DA will be admissible to me in such cases. 5. I have completed my B.Tech as on date. NOTE: Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ORDINARY POST ONLY. You will be intimated via Email or SMS regarding your SSB Call-up, if shortlisted. Kindly check your Email inbox regularly. Place ______________ Date _____________ October 31, 2015, 8:39 am Signature of Applicant 2015-10-31 08:33:06
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Transcript of Applicationform
PGD1630403116
APPLICATION FORM FOR Permanent Commission (PC) Education Jun16 BATCH
(Affix Photograph)
(UNMARRIED CANDIDATES ONLY)FOR INDIAN NAVY OFFICE USE ONLY
Code No: For Office use only: Application No:
VALID / INVALID
1. CHOICE OF ENTRY : [2] SSC(LOG) [1] PC(EDU)
2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:
NAME: MOHAN KUMAR JHA DATE OF BIRTH: 1993/01/12
FATHER'S NAME: UDAY KANT JHA FATHER'S OCCUPATION: PRIVATE JOB
DOMICILE: Bihar GENDER: Male
3.NATIONALITY: INDIAN 4.MARITIAL STATUS: Unmarried 5.EMAIL: [email protected]
6. ADDRESS: PERMANENT PRESENT
VILL-MAHNAPO-MAHNA VILL-MAHNAPO-MAHNA
DISTRICT BEGUSARAI BEGUSARAI
STATE Bihar Bihar
PINCODE 851210 851210
TELEPHONE --NA-- 06243-265570
MOBILE --NA-- 9973467214
7. EDUCATION PARTICULARS:
Qualification Stream Year of Passing Percentage
B.Tech Electronics and Communication 2014 77.35%
Maximum Marks Marks Obtained Maximum Marks Marks Obtained
1st Semester 1000 715 2nd Semester 1000 782
3rd Semester 1000 762 4th Semester 1000 748
5th Semester 1000 809 6th Semester 1000 771
7th Semester 1000 786 8th Semester 1000 815
8. I HAVE NOT ATTENDED ANY SSB INTERVIEW TILL DATE
9. Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and obtain NOC from the present employer.) : NA
DECLARATION
1.I, hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never beenarrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police.2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief.3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.4. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiated against me for fraudulent entry and falsification of GOIdocuments. I also accept that no TA/DA will be admissible to me in such cases.5. I have completed my B.Tech as on date.
NOTE:Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ORDINARY POSTONLY. You will be intimated via Email or SMS regarding your SSB Call-up, if shortlisted. Kindly check your Email inbox regularly.
Place ______________ Date _____________ October 31, 2015, 8:39 am
Signature of Applicant2015-10-31 08:33:06
