Application of Job: UNIVERSITY ENTRY SCHEME - 2020

Application No: UGE206M004543 Application Date: 27/06/2019

1. PRIORITY

1. SSC [SSC(ENG_U)] 06/2020

2. PERSONAL PARTICULARS

Name: NAMAN KUMAR Nationality: INDIAN

Father's/Mother's Name: LATE NAVEEN CHANDRA Gender: MALE
Date of Birth: 15/05/1998 Guardian's Name: GAUTAM KUMAR
Identification Mark 1: WHIT ON LEFT PALM
Identification Mark 2: ---------

EDUCATION PARTICULARS

Details of Graduation

Dr. A.P.J. Abdul Kalam

Second Highest Technical University
B.Tech Marks Available In : PERCENTAGE University Name :
Qualification : Uttar Pradesh,
Lucknow
Kamla Nehru Institute
Mechanica
Stream : College Name : of Technology,
l
Sultanpur
Aggregate
In Final
Candidate Status : Percentage till 5 66.34 College State : UTTAR PRADESH
year
semester
Candidate Type : Regular Passing Year : 2020 College District : SULTANPUR

Details of 12th Science

Subjects Total Marks Obtained Marks

English 100 83

Hindi 100 75

Physics 100 89

Chemistry 100 94

Maths 100 96
Total Marks: 500 Marksheet Serial Number: 1046019
Obtained Marks: 437 State Conduct: UTTAR PRADESH
Percentage: 87.40 Board Conduct: State Board

Details of 10th

Total Marks: 600 Marksheet Serial Number: 2273175

Obtained Marks: 467 State Conduct: UTTAR PRADESH
Percentage: 77.83 Board Conduct: State Board

4. MILITARY RECORD

Have you ever been enrolled in Armed Forces before?: ---------

Have you attended any Services Selection Board (SSB) before?: NO

Have you been discharged from Armed forces before?: ---------

5. COMMUNICATION PARTICULARS

Details of Permanent Address Details of Correspondence Address

Address 1: PURANA QILA CANTT ROAD LUCKNOW Pincode: 226001 Same as Permanent Address
Address 2: KNIT SULTANPUR,228116 Mobile No.: 6386447732
State: UTTAR PRADESH Email id: naman1551998@gmail.com
District: LUCKNOW

A. 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.

B. 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.

C. I fully understand that in the event of my information being found false or incorrect, appropriate action can be taken against me.

D. 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 Government of India documents. I also accept that no TA/ DA will be
admissible to me in such cases.

6. APPLICATION FORM TO BE SIGNED BY THE DIRECTOR OF ENGINEERING COLLEGE/HEAD OF DEPARTMENT

Certified that Miss/Mr .............. is studying in this University/College/Institute and that details furnished by him in para 3 and
4 of application form have been checked with refrence to relevant records and found correct.
Place:........... Date:................ Signature(Director/HOD):..............................

CAMPUS VENUE DETAILS (TO BE FILLED IN BY THE APPLICANT)

DATE: COLLEGE VENUE: SIGN:

FOR OFFICE USE ONLY

GRADE: SIGNATURE: