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A.

BASIC DETAILS : Registration id: 31130263


1. Post applied for : Executive/Legislative/Committee/Protocol Assistant

2. Category : OBC

3. Indian National : Yes

4. Aadhaar Card/Enrollment Number :

5. Physically Challenged : No

6. if yes,indicate the nature of disability : 1.Locomotor : NO 2.Low Vision : NO 3.Partially Deaf: NO

7. Examination Centre : Chennai

8. Additionally,Please state whether Ex - Serviceman: No

9. Date of Discharge :

If so, indicate the length of service : 0 Years 0 Months 0 Days

10.Regular Government Servent: No

If so, indicate the length of regular and continous service : 0 Years 0 Months 0 Days

11. I have intimated my office/department in writing :

12.Regular Lok Sabha Secretariat Employee: No

If so, indicate the length of regular and continous service : 0 Years 0 Months 0 Days

13. I have informed AN Branch-I in writing :

14. Is your service as Goverment Servant and as Lok Sabha Secretariat


Employee continous and combined.

B. PERSONAL DETAILS
1. Candidate's name[Name as recorded in the MADHAN C
Matriculation/Secondary School Examination
certificate] :

2. Date of birth : 24/12/1991

3. Age completed as on 01.12.2016: 24.11.9

4. Gender : Male

5. Father's name : VS CHINNUSAMY

6. Mother's name : VC ESWARI

7. Address for correspondence : SEVEN VATAKALA VALASAR STREET


VENGIYAMPALAYAM PASUR ERODE

8. State : Tamil Nadu

9. Pin Code : 638154

C. CONTACT DETAILS
1. Mobile no. : 9940953954

2. Email-id : madhanvc8@gmail.com

3. Confirm email-id : madhanvc8@gmail.com


D. EDUCATIONAL QUALIFICATION DETAILS
Examination Passed Institution/University Name of the Medium of Duration of Study Year of Passing % of Marks
Subject/Stream Instruction

1. SSC/Matriculation TAMILNADU ENGLISH MEDIUM ENGLISH 1 2007 82.50


: STATEBOARD

2. 10+2 or HSC or TAMILNADU BIOLOGY MATHS ENGLISH 1 2009 75.00


Equivalent : STATEBOARD

3. Graduation : ANNA UNIVERSITY COMPUTER ENGLISH 4 2013 71.90


SCIENCE

4. Post Graduation :

5. Certificate in
Computer Course:

6. Others :

7. Do you posses any of the desirable qualification : Yes

DEGREE IN COMPUTERSCIENCE IN ENGINERING

Declaration :
I declare that I have read the relevent advertisement and I fulfil the eligibility conditions as per the advertisement and 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 false or
incorrect at any stage or not satisfying the eligibility conditions according to the requirements mentioned in the advertisement, my candidature/appointment
is liable to be cancelled/terminated. I have also noted that if my application is found incomplete/defective, the same is liable to be rejected summarily and no
correspondence will be entertained by Lok Sabha Secretariat in this regard.

Note : Please take Printout of your data after final submission and save the registration number for reference in any future communication with JRC. After
final submission changes are not allowed.

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