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ODISHA STAFF SELECTION COMMISSION

Barrack No.1, Unit No.-V, Bhubaneswar-751054 | Tel: 0674- 2393770 | Fax: 0674-2391153
Application Form 141207048283
Applicant Copy (To be retained by the applicant)

07 -
1. Post Code and Name
Combined Auditor
Option Post Name
Option Details 1 Local Fund Audit
2 Auditor Rdc Sd Berhampur

2. Advertisement No. and Date 3929 - 24-Dec-2014

Choice of district for
3. Bhubaneswar
appearing in the examination
4. Full Name Of the Applicant Mrs. Rasmita Bhanja

5. Father's Name Mr. Dhurba Charan Bhanja

6. Mother's Name Mrs. Basanti Bhanja

7. Name of the husband in case of Married female applicant

Mr. Sugyan Kumar Jena

8. Personal Details
a. Nationality b. Sex c. Date of Birth. d. Age as on 01-Jan-2014
Indian Female 01-Jun-1983 Year 30 Month 7
Reservation NCC Certificate
e. f. g. Physically Challenged (Yes / No) h. Type of Physical disability
Category received, if any
UR NA No NA
Period of
Service
Whether Date/ Likely Date of Discharge (in Whether passed minimum
i. j. rendered (in k. I.
Ex-Serviceman case of Ex-Serviceman) Seventh class Exam. in Odia
case of
Ex-Serviceman)
No NA NA Yes
Whether holder
of Sports ID card no. issued by Director of Sports (in case of
m. n. o. State Level Medal
Person Sports Person)
Certificate
No NA No
National Level
p. q. International Level Medal r. InService
Medal
No No No
s. From t. To u. Total In-Service Experience
-- -- 0.0

9. Address for Correspondence (All Communication to the candidate from OSSC is to be made in this address)
Address with
a. Plot-No. 952/3735 Behera Sahi Post- Nayapalli Bhubaneswar ,Pincode: 751012
Pincode:
b. District : Bhubaneswar c. State : Odisha

d. Telephone : 0674-2421575 e. Mobile : 9439191101 f. e-Mail : db.rasmita@gmail.com

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10. Permanent Address

Address with
a. Plot-No. 952/3735 Behera Sahi Post-Nayapalli Bhubaneswar ,Pincode: 751012
Pincode:
b. District : Bhubaneswar c. State : Odisha

11. Educational Qualification

10th Standard Roll Number As Mentioned in the Certificate 67TC093

10th Standard Exam Type Annual

Total Secured
Examination Stream Board/University YOP Division %Age
Marks/CGPA Marks/CGPA
HSC *** BSE, ORISSA 1998 First 750 496 66.13
10+2/DIPLOMA SCIENCE CHSE, ORISSA 2000 Second 1100 558 50.72
BACHELOR IN UTKAL UNIVERSITY
DEGREE 2003 Second 1800 904 50.22
PHYSICS ODISHA

12. Treasury Challan Details (Original Challan has to be submitted along with the hard copy of the application) -
(Candidates belonging to SC/ST/PWD Categories are exempted from paying the exam fees.)
Treasury Challan / Reference
22F4464B23 Date : 27-Jan-2015
Number:
Name of Treasury Bhubaneswar No I Amount 100

Desariable Qualification
Have you Basic knowledge in Computer ?* Yes

13. Application Details

Password
Applicant Id : 141207048283 93E1128854
:

NB : Your Online application has been submitted successfully.

ODISHA STAFF SELECTION COMMISSION

Barrack No.1, Unit No.-V, Bhubaneswar-751054 | Tel: 0674-2393770 | Fax: 0674-2391153
Application Form 141207048283
OSSC Copy
To be Submitted to The Secretary, OSSC ,Barrack No.1, Unit No.-V, Bhubaneswar-751054,Odisha by Speed Post / Registered Post.
07 -
1. Post Code and Name
Combined Auditor
Option Post Name
Option Details 1 Local Fund Audit
2 Auditor Rdc Sd Berhampur

2. Advertisement No. and Date 3929 - 24-Dec-2014

Choice of district for
3. Bhubaneswar
appearing in the examination
4. Full Name Of the Applicant Mrs. Rasmita Bhanja

5. Father's Name Mr. Dhurba Charan Bhanja

6. Mother's Name Mrs. Basanti Bhanja

7. Name of the husband in case of Married female applicant
Mr. Sugyan Kumar Jena

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8. Personal Details
a. Nationality b. Sex c. Date of Birth. d. Age as on 01-Jan-2014
Indian Female 01-Jun-1983 Year 30 Month 7
Reservation NCC Certificate Physically Challenged (Yes /
e. f. g. h. Type of Physical disability
Category received, if any No)
UR NA No NA
Period of Service Date/ Likely Date of
Whether Whether passed minimum Seventh
i. j. rendered (in case k. Discharge (in case of l.
Ex-Serviceman class Exam. in Odia
of Ex-Serviceman) Ex-Serviceman)
No NA NA Yes
Whether holder
ID card no. issued by Director of Sports (in case of
m. of Sports Person n. o. State Level Medal
Sports Person)
Certificate
No NA No
National Level
p. q. International Level Medal r. InService
Medal
No No No
s. From t. To u. Total In-Service Experience
-- -- 0.0

9. Address for Correspondence (All Communication to the candidate from OSSC is to be made in this address)
Address with
a. Plot-No. 952/3735 Behera Sahi Post- Nayapalli Bhubaneswar ,Pincode: 751012
Pincode:
b. District : Bhubaneswar c. State : Odisha

d. Telephone : 0674-2421575 e. Mobile : 9439191101 f. e-Mail : db.rasmita@gmail.com

10. Permanent Address

Address with
a. Plot-No. 952/3735 Behera Sahi Post-Nayapalli Bhubaneswar ,Pincode: 751012
Pincode:
b. District : Bhubaneswar c. State : Odisha

11. Educational Qualification

10th Standard Roll Number As Mentioned in the Certificate 67TC093

10th Standard Exam Type Annual

Total Secured
Examination Stream Board/University YOP Division %Age
Marks/CGPA Marks/CGPA
HSC *** BSE, ORISSA 1998 First 750 496 66.13
10+2/DIPLOMA SCIENCE CHSE, ORISSA 2000 Second 1100 558 50.72
BACHELOR IN UTKAL UNIVERSITY
DEGREE 2003 Second 1800 904 50.22
PHYSICS ODISHA

12. Treasury Challan Details (Original Challan has to be submitted along with the hard copy of the application) -
(Candidates belonging to SC/ST/PWD Categories are exempted from paying the exam fees.)
Treasury Challan / Reference
22F4464B23 Date : 27-Jan-2015
Number:
Name of Treasury Bhubaneswar No I Amount 100

Desariable Qualification
Have you Basic knowledge in Computer ? Yes

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DECLARATION
I __________________________ Son/ Daughter of Shri _________________________Age___________ Year__________
resident of ________________ District ________________ hereby declare that the information given above and in the enclosed
documents is true to the best of my knowledge and belief and nothing has been concealed therein. I am well aware of the fact that if
the information given by me is proved false/ not true, I will have to face the punishment as per the law. Also, all the benefits availed
by me shall be summarily withdrawn.

Signature should not exceed the box provided

Date
:
Place
:

Full Signature of the Applicant (Ink Signed)

NB: Attach the enclosures as specified at item 12 and 13 of the above list and post the application to the Secretary Odisha Staff
Selection Commission, Barrack No.1, Unit No.-V, Bhubaneswar - 751054.

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Sender By Post

From
Application for the Post of : Combined
Auditor
Name Mrs. Rasmita Bhanja
Father's Name Mr. Dhurba Charan Bhanja To

Plot No, / Lane Plot-No. 952/3735 Behera Sahi The Secretary,

Name / Village Post- Nayapalli Bhubaneswar Odisha Staff Selection Commission,
Barrack No.1,
District Name Bhubaneswar
Unit No.-V,
PIN Code 751012
Bhubaneswar-751054 .
Tel: 0674- 2392233
Fax: 0674-2391153

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