Application Form 901190001185

Advt. No. CEPTAM-09/STA-B DRDO ENTRY TEST-2018 Crucial date of Eligibility:29-08-2018

For Office Use Only

Online Application Number: 901190001185
Generated On Date: 29-10-2018 14:43

8. Nationality: INDIAN
9. Identity Proof Type:
1. Post Code & Post Name: [STA-B]-0119-Physics Aadhaar Card No. 4961 1133 5888
2. Exam City Preference:28-KOLKATA, 43-SILIGURI, 12- 10. Gender: Male
GORAKHPUR
3. Candidate’s Name: SAGARDWEEP BISWAS 11. Contact Details:
4. Father’s Name: CHINMAY BISWAS
5. Mother’s Name: ILA BISWAS a) Correspondence Address: TARULATA
6. Date of Birth: 06-11-1994 PATH,DESHBANDHU PALLY
Age as on Crucial Date: 23Y,9M,23D District: North 24 Parganas City: NAIHATI
State: WEST BENGAL Pincode: 743165
7.a) Category
[ ] Unreserved(UR) [ ] Scheduled Caste (SC) (if Permanent Address same as Correspondence Address) [ ]
[ ] Scheduled Tribe (ST) [ ] OBC (Creamy Layer) b) Permanent Address: TARULATA PATH,DESHBANDHU
[ ] OBC (Non-Creamy Layer) PALLY
District: North 24 Parganas City: NAIHATI
(if ST/SC/OBC-NCL) State: WEST BENGAL Pincode: 743165
Certificate no:
A73538/SC/ST/BKP c) Mobile No: 8420299165
d) Alternate No: 7908696155
Date of issue: 13-07-2011 e) Email ID: sagar94m@gmail.com

12. Essential Qualifications

a) Do you possess EQR as per CEPTAM-09/STA-B Advt. (Diploma /B.Sc.) as on crucial date of eligibility: YES[ ] No[ ]

b) Do you possess B.Sc./Diploma/Both : B.Sc.[ ] Diploma [ ] Both(Diploma and B.Sc.)[ ]

Mode of
University/ Year of Max. Marks/ Marks/ CGPA % of Marks
Qualification Degree/ Main Subject Roll No.
Board Passing CGPA obtained Secured
Qualification
BENGALI
ENGLISH
WEST
MATHEMATIC
BENGAL
S PHYSICAL
X Regular C31801G 0526 BOARD OF 2011 800.00 649.00 81.12
SCIENCE LIFE
SECONDARY
SCIENCE
EDUCATION
GEOGRAPHY
HISTORY
BENGALI WEST
ENGLISH BENGAL
PHYSICS COUNCIL OF
XII Regular 210311 0805 2013 500.00 337.00 67.40
CHEMISTRY HIGHER
MATHEMATIC SECONDARY
S BIOLOGY EDUCATION
THE
B.Sc Regular PHYSICS 14SH405 0076 UNIVERSITY 2016 800.00 430.00 53.75
OF BURDWAN

c) Subject mentioned on EQR: BSC

d) Higher Qualification (B.E., B.Tech, M.Sc, M.Tech, Ph.D., etc)

Are you Pursuing YES[ ] NO [ ] Have you Completed YES [ ] NO [ ]
Degree Likely Date of Completion Degree Date of Completion
NA NA M.Sc 20-05-2018

13. a)Application Fee of Rs. 100/- Paid (If not exempted as per Govt. rules)

Payment Status EXEMPTED

14. Physical Measurements:
a) Height (cm): 161.50 b) Weight(kg): 59.00 c) Visible Identification Mark: NO
15. Special Categories (if any) :
a) Do you belong to Minority community: Yes [ ] No[ ]
b) Domiciled in J&K during 01/01/1980 to 31/12/1989 : Yes[ ] No [ ]
c) Defence Personnel with Disability: YES [ ] NO [ ]
16.Posting Preference

Preference 1 2 3 4 5 6 7
Location
P2 H2 D2 V1 C1 D1 K2
(City Code)
17.List of Documents Uploaded
10th class or equivalent Certificate
I hereby give my consent to disclose my particulars, score and rank of examination publically (refer 5.2 of CEPTAM-
09/STA-B Advertisement) on the website. [ ] Yes [ ] No
18. Declaration
I SAGARDWEEP BISWAS son/daughter of CHINMAY BISWAS hereby declare that
a) I have read and understand all the provisions mentioned in the advertisement and undertake to abide by them.
b) All the statements made in this application are true, complete and correct to the best of my knowledge and belief.
c) I have submitted only one application for one post in response to this advertisement.
d) I understand that in the event of any information being found suppressed, false or incorrect or any ineligibility being
detected before or after the examination/recruitment, my candidature/recruitment/ appointment is liable to be cancelled.
19. Required at the time of document verification, if shortlisted

Place:

Date:

a) Left Hand Thumb Impression b) Signature of Candidate

Note:- You are NOT REQUIRED to send print out of your application to the CEPTAM/DRDO at this time. However, it is advised to
keep this application form and copy of the advertisement for claiming travel concession from Railways, and also for future
references. CEPTAM does not undertake any Detailed scrutiny of application before examination and the eligibility is verified only
after examination. Accordingly, mere allowing the candidates to appear in the examination will not be construed as a ground of
being eligible for the post applied

Online Application Number: 901190001185 , Generated on 29-10-2018 14:43