Staff Selection Commission

Block No. 12, CGO-Complex, Lodhi Road, New Delhi 110003

Recruitment of Combined Graduate Level Examination, 2018
Registration No: 63003493218

Application Status: Application provisionally submitted

Name of the Examination Centre Examination Centre Code

ER-Kolkata(4410) 4410
ER-Barasat(4402) 4402
ER-Chinsurah(4405) 4405

Candidate's Full Name Father's Name Mother's Name Date of Birth

PAROMITA GUHA ROY PARIJAT GUHA ROY SHIKHA GUHA ROY 1991-04-19

Gender Nationality Fee Category

Female Indian Exemption claimed General

Fee Option Amount Transaction-ID Transaction Date

Whether Ex-serviceman Length of Service (in years) Date of Discharge If ExS, Whether eligilble for
reservation
No

Whether If yes,type Do you Do you suffer from Locomotor Whether scribe is If yes,
Person with of suffer from Disability (40% or more) wherein the required in case of indicate
Disability disability(O Cerebral dominant writing extremity is affected VH/Cerebral medium
(PwD)? H,HH,VH,O Palsy (40% to the extent of slowing down the Palsy/Locomotor
thers) or more) ? performance? Disability (40% or
more)?
No

Age as on (01.08.2018) Whether seeking Age relaxation? Age Relaxation code

27.3 No

Are you also applying for the Do you possess EQ for the Whether belong to Minority Mark of visible identification
Post of Junior Statistical Post of Junior Statistical Communities as per Govt.
Officer ? Officer ? Orders?
No No No A SMALL BLACK CUT MARK
ON NOSE

Educational Qualification (Please note that possession of Graduate Qualification is a pre-requisite to apply for this
examination,However you may indicate your highest qualification)
M.Sc

Do you want to make available your personal information for accessing job opportunity in terms of Dop&T's O.M
No.39020/1/2016-Estt.(B) dated 21.06.2016?
Yes

Address Detail
Communication Address Permanent Address
RAMKRISHNA PALLY JAGAR MATH PRAGATISANGHA CLUB RAMAKRISHNA PALLYJAGAR MATH POST OFFICE-RAHARA
P.O-RAHARA P.S-KHARDAH POLICE STATION-KHARDAH DIST- 24 PARAGANAS NORTH
City: KHARDAH State: West Bengal
District: NORTH TWENTY FOUR PARGANAS Pin Code: 700118
State: West Bengal Mobile No.: 9163632105
Pin Code: 700118 Email Id: prparamitaroy@gmail.com
 Declaration
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

Printed on:(mm/dd/yyyy): 05/08/2018 15:51:48