Page 1 of 5 12) Address For Communication Permanent State: Pin: State: Pin: Phone (R) :………………………………... Phone (O) :………………………………... Mobile :………………………………... 13) Category SC* OBC* (Put marks) √ ST* UR (*Attach a certificate from the competent authority prescribed by the Government of 14) Whether Physically Challenged (Put marks) √ Yes No If yes VH [ ] OH [ ] Disability………………… (%) (*Attach a certificate from the competent authority as prescribed under government rules) 15) Educational Qualification (10th Std onwards) (Attach self-attested copies) Month Marks and Sr. Examination/Degree Board/University Subjects Percentage/Division Obtained/Total No Year of Marks Passing Signature of Applicant
Page 1 of 5 12) Address For Communication Permanent State: Pin: State: Pin: Phone (R) :………………………………... Phone (O) :………………………………... Mobile :………………………………... 13) Category SC* OBC* ST* UR (Put √ marks) (*Attach a certificate from the competent authority prescribed by the Government of Yes No 14) Whether Physically Challenged (Put √ marks) If yes VH [ ] OH [ ] Disability………………… (%) (*Attach a certificate from the competent authority as prescribed under government rules) 15) Educational Qualification (10th Std onwards) (Attach self-attested copies) Sr. No Examination/Degree Board/University Subjects Month and Year of Passing Percentage/Division Marks Obtained/Total Marks Signature of Applicant
Application%20Format%20(M.S.%20Word%20Format)_16022018.docx