STAFF SELECTION COMMISSION

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

110003
Stenographer Grade µC¶and µD Examination, 2019

REGISTRATION NO: 92000559098

APPLICATION IS PROVISIONALLY ACCEPTED

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFIC NAME
HARSH KUMAR - KAMAL SINGH CHANDANI DEVI
5. DATE OF BIRTH 6. AGE AS ON
7. GENDER 8. CATEGORY
(DD/MM/YYYY) 01/01/2020
06/06/1999 20.6 MALE UNRESERVED
9. WHETHER PERSON WITH DISABILITY (PWD) ? 9.1 IF YES, TYPE OF DISABILITY (OH, HH,VH, OTHERS)
NO -

10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION

CITIZEN OF INDIA A MOLE ON RIGHT EYE
12. MATRICULATION (10th CLASS) EXAMINATION 13. MATRICULATION (10th 14. MATRICULATION (10th
BOARD CLASS) ROLL NO CLASS) YEAR OF PASSING
BIHAR SCHOOL EXAMINATION BOARD 1500481 2015
15. DO YOU BELONG TO ECONOMICALLY WEAKER SECTIONS (EWS) ? 16. DO YOU POSSESS KNOWLEDGE
OF STENOGRAPHY ?
YES YES
17. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER ( FIRST ) EXAMINATION CENTER ( SECOND ) EXAMINATION CENTER ( THIRD )
PATNA ( 3206 ) MUZAFFARPUR ( 3205 ) AGRA ( 3001 )
18.WHETHER EX- 18.1. HAVE YOU ALREADY 18.2. LENGTH OF SERVICE IN 18.3. DATE OF DISCHARGE
SERVICEMAN (ESM) ? JOINED A CIVIL POST BY ARMED FORCES ( IN YEARS ) FROM ARMED FORCES
AVAILING BENEFIT OF (DD/MM/YYYY)
RESERVATION FOR EX-
SERVICEMAN (ESM) ?
NO - - -
19. DO YOU HAVE A PHYSICAL LIMITATION TO WRITE AND SCRIBE IS REQUIRED TO WRITE ON YOUR BEHALF
(CERTIFICATE TO THIS EFFECT FROM THE CHIEF MEDICAL OFFICER/ CIVIL SURGEON & MEDICAL
SUPERINTENDENT OF A GOVERNMENT HEALTH CARE INSTITUTION AS PER NOTICE OF THE EXAMINATION
WOULD BE REQUIRED AT THE TIME OF EXAMINATION) ?
NO
19.1 WHETHER SCRIBE IS REQUIRED ? 19.2 WILL YOU MAKE YOUR OWN 19.3 IF SCRIBE IS TO BE ARRANGED
ARRANGEMENT OF SCRIBE ? BY SSC, INDICATE MEDIUM
NO - -
 20. LANGUAGE/ MEDIUM OF SKILL TEST
ENGLISH
22. WHETHER SEEKING AGE RELAXATION ?
NO
23. QUALIFICATION DETAILS
INTERMEDIATE/ HIGHER SECONDARY/ 10+2 (2)
21. POST(S) APPLYING FOR
BOTH (STENOGRAPHER GRADE C AND GRADE D)
22.1 IF YES,INDICATE CODE
-
24. 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 ?
NO

ADDRESS DETAIL
25. POSTAL ADDRESS 26. PERMANENT ADDRESS
ATT RAGHUNATHPUR POST KISHANPUR DISTRICT ATT RAGHUNATHPUR POST KISHANPUR DISTRICT
SAMASTIPUR SAMASTIPUR
DISTRICT: SAMASTIPUR DISTRICT:SAMASTIPUR
STATE: BIHAR STATE: BIHAR
PIN : 848301 PIN : 848301
MOBILE NO: 7493058136 EMAIL: harshrajchintu@gmail.com
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
NOT EXEMPTED 100 CPV4731914 14/10/2019
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF
THE NOTICE OF THE EXAMINATION.

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.
PRINT TAKEN ON: 21/11/2019 5:49:31 PM