Print Application Form

UTTAR PRADESH SECONDARY EDUCATION SERVICES SELECTION BOARD

I Declare that I have Read the detailed User Manul & Notification.

Notification Details ( Examination )

Advertisement/Notification
Number :

02/2016-EXAM / General

Apply For :

2016 - /

Candidate's Personal Details

Application ID :

UP0020091461002000785

Candidate Registration No. :

UP00210020051373

Candidate Name :

JAMUNA SOLANKI

Father's/Husband's Name :

RAJENDRA SINGH

Mother's Name :

CHAMPA DEVI

Gender - Date of Birth :

Female - 27/06/1990

Are you Domicile of UP? / Catgory : Yes / GENERAL

Are you Married?

Yes

Contact No./ Email-ID :

8769214345 / solankigcti16@gmail.com
Bank Transaction Details

Bank Name - Payment Mode :

State Bank Of India - INB

Fees, Transaction ID - Date:

Rs. 625.00 , CP51228371 - 17/06/2016

Other Details of Candidate

Are you Dependent of UP Freedom

Fighter?

No

Service Duration (Day-Month-Year) :

0
0
0

Are you ECO/SSCO/CO of Army ?

Are you UP Ex. Army?

No

Retirement Date(Date/Month/Year) :

//

Have you complete 5 year service ?

Have your services been extended for

rehabilitation and no disciplinary action
is pending against you ?

Have you ever been Debarred from any

Selection Board/Commission ? :

Completion Date of Debarment

(DD/MM/YYYY) :

Are You Handicap of UP?

Are you Blind Or Have Vision problem? : No

Are you Deaf or Have hearing problem? : No

Have you any physical Problem? :

No

Are You Skilled Player Of UP? :

Level of Player :

No

N/A

No

High School & Intermediate Board,Year of passing & Roll Number Details
Sr.No Examination Board Name
Passed

Year of
Passing

Roll
Obtained
Number Marks

Total
Marks

1.

2004

0004923 344

600

2006

017588 289

500

High School UTTAR PRADESH BOARD OF HIGH SCHOOL AND

INTERMEDIATE EDUCATION
2.

Intermediate UTTAR PRADESH BOARD OF HIGH SCHOOL AND

INTERMEDIATE EDUCATION

Choice of
Examination Center
District :

1 : AGRA
2 : KANPUR NAGAR
3 : LUCKNOW

Essential Qualification Details

Qualification

Year
Roll
Passed/Appeared Board/Inst/Univ Of
Number
Passing

Yes

Is
Obtain Total Percentage
Grade
Marks Marks (%)
System

Dr bhimrao
ambedkar
2009
university, Agra

9185035033 No

621.00 1200.00 51.75

Yes

university of
Rajasthan

2015

1302369

No

378.00 900.00 42.00

0 0 0 0
00 Yes

university of
Rajasthan

2012

17119

NA

00





000/
0 0

No

NA

NA

No

NA

NA

Address Details

Candidate's
Permanent Address

Candidate's
Correspondence/Mailing
Address

Photo Signature
Details

Name (C/O) :

RAJENDRA SINGH

RAJENDRA SINGH

Photo&Signature

House no./Village :

MIDHAKUR

MIDHAKUR

Street No./Post Office :

MIDHAKUR

MIDHAKUR

UTTAR PRADESH /

UTTAR PRADESH /

AGRA

AGRA

Tahsil:

AGRA

AGRA

Police Station :

MALPURA

MALPURA

Block :

BICHPURI

BICHPURI

Village :

MIDHAKUR

MIDHAKUR

PIN :

283105

283105

State / District Name :

1. I hereby declare that I have read all the provisions in the notice/advertisement of the examination
carefully and hereby undertake to abide by them
2. I further declare that I fulfill all the conditions of eligibility regarding age limits,educational
qualifications etc. prescribed for admission to the examination.
3. I decalre that my claim for reservation as SC /ST/OBC candidate's are true and correct and I am in
possession of my caste certificate in the prescribed format given in the notice/advertisement of the
examination .I also declare that as per Govt. order No.22/16/92/T.C.-III DATED 22-10-2008 I do not belong
to the person/sections (creamy layer) mentioned in it.
4. I (for male candidates ) also declare that I have no more than one wife living/(for female candidates)
have not married a man already having a wife living.
5. I also declare that I have never been convicted by any court of law. I also declare that no criminal
case is pending against me. Further declare that I have never been dismissed or removed from Govt.
Service or my service been terminated during probation.
6. I hereby declare that all the entries /statements made in this application are true ,complete and
correct to the best of my knowledge and belief. In the event of any information being found false or
incorrect or ineligibility being detected before or after selection the Board can take action against me
as per rules in case it is detected that I have mislead the Board on any issue then I will solely
responsible for all penal consequences thereof.

I accept the above declaration : Yes

Current status of application
Your application is under processing.
Application Form Submission Date :

18/06/2016 , Time : 4:24:00 PM

Application Form printing Date & Time : [ 18/06/2016 ,4:24:20 PM ]