STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
CONSTABLE(EXECUTIVE) MALE AND FEMALE IN
DELHI POLICE EXAMINATION
2020
REGISTRATION NO: 30001672974

APPLICATION IS PROVISIONALLY ACCEPTED

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION NAME
CERTIFICATE
PRIYA BAGHEL - VIJAY BAGHEL GAYTRI BAGHEL
5. DATE OF BIRTH
6. AGE AS ON 01/07/2020 7. GENDER 8. CATEGORY
(DD/MM/YYYY)
27/04/1994 26.2 FEMALE OBC
9. NATIONALITY 10. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA A MOLE ON FACE
11. MATRICULATION (10th CLASS) EXAMINATION 12. MATRICULATION (10th 13. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BOARD OF HIGH SCHOOL AND INTERMEDIATE
0057598 2010
EDUCATION UTTAR PRADESH
14. DO YOU BELONG TO A CASTES NOT INCLUDED IN CENTRAL LIST OF OBCs BUT NOTIFIED AS OBC BY THE GOVT
OF NCT OF DELHI ?
NO
15. WHETHER DEPARTMENTAL CANDIDATE OF DELHI POLICE ?
NO
16. WHETHER SON/ DAUGHTER OF SERVING, RETIRED OR DECEASED PERSONNEL/ MULTI-TASKING STAFF OF DELHI
POLICE
NO
17. HAVE YOU REPRESENTED A STATE AT THE NATIONAL LEVEL OR THE 17.1. IF YES, INDICATE DISCIPLINE OF
COUNTRY AT THE INTERNATIONAL LEVEL IN SPORTS DURING PRECEEDING YOUR SPORT
3 YEARS FROM THE CLOSING DATE OF RECEIPT OF ONLINE APPLICATIONS?
NO -
18. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
AGRA ( 3001 ) KANPUR ( 3009 ) LUCKNOW ( 3010 )
 19.WHETHER EX- 19.1. DATE OF DISCHARGE 19.2. HAVE YOU ALREADY JOINED A CIVIL POST BY
SERVICEMAN (ESM)? FROM ARMED FORCES AVAILING BENEFIT OF RESERVATION FOR EX-
(DD/MM/YYYY) SERVICEMAN (ESM) ?
NO - -
19.4. LENGTH OF SERVICE IN ARMED FORCES (IN
19.3. DATE OF JOINING THE CIVIL POST (DD/MM/YYYY) YEARS)

- -
20. WHETHER ELIGIBLE FOR SPECIAL QUOTA AS ESM FOR DELHI POLICE ?

21. WHETHER SEEKING AGE 21.1. IF YES,INDICATE CODE

RELAXATION ?

YES 02-OBC

22. ARE YOU A NATIONAL CADET CORPS (NCC) CERTIFICATE HOLDER ? 22.1. TYPE OF CERTIFICATE

NO -
24. DETAILS OF QUALIFYING
23. HIGHEST QUALIFICATION
EDUCATIONAL QUALIFICATION
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2) 12TH
BOARD/ YEAR OF
ROLL NO SUBJECTS PERCENTAGE CGPA
UNIVERSITY PASSING
BOARD OF
HIGH
SCHOOL AND
INTERMEDIA
0018437 ENGLISH HINDI BANKING ACCOUNTS 2012 68 -
TE
EDUCATION
UTTAR
PRADESH
ADDRESS DETAILS
25. POSTAL ADDRESS 26. PERMANENT ADDRESS
7/26 C JAWAHAR NAGAR KHANDARI CIVIL LINE AGRA 7/26 C JAWAHAR NAGAR KHANDARI CIVIL LINE AGRA
282002 282002
DISTRICT: AGRA DISTRICT:AGRA
STATE: UTTAR PRADESH STATE: UTTAR PRADESH
PIN : 282002 PIN : 282002
MOBILE NO: 6398380127 EMAIL: rsjadoun207@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED - - -
DECLARATION
1. I HAVE READ THE NOTICE OF EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS MENTIONED
THEREIN.

2. I HEREBY DECLARE THAT ALL 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 SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE
CANCELLED.I AM WILLING TO SERVE ANYWHERE IN INDIA.
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