Application Form 901160017610

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

For Office Use Only

Online Application Number: 901160017610
Generated On Date: 12/08/2018 23:14 hrs

8. Nationality: INDIAN
1. Post Code & Post Name: [STA-B]-0116-Mechanical 9. Identity Proof
Engineering Type: Aadhaar Card ID Number: 5265 8730 4620
2. Exam City Preference:08-CHANDIGARH, 11-DELHI NCR, 45- 10. Gender: Male
VARANASI
3. Candidate’s Name: IRSHAD ANSARI 11. Contact Details:
4. Father’s Name: FAHIMUDDIN ANSARI
a) Correspondence Address: BH-03 ,ROOM NO-99, SLIET
5. Mother’s Name: SARVARI VANO
LONGOWAL SLIET LONGOWAL
6. Date of Birth: 22/09/1997
District: Sangrur City: SANGRUR
Age as on Crucial Date: 20Y,11M,7D
State: PUNJAB Pincode: 148106
7.a) Category
(if Permanent Address same as Correspondence Address) [ ]
[ ] Unreserved(UR) [ ] Scheduled Caste (SC)
b) Permanent Address: VILL-GANDHI,TEHSIL GYANPUR,
[ ] Scheduled Tribe (ST) [ ] OBC (Creamy Layer)
PO-SAGAR RAIPUR
[ ] OBC (Non-Creamy Layer)
District: Bhadohi City: BHADOHI
(if ST/SC/OBC-NCL) State: UTTAR PRADESH Pincode: 221310
Certificate no: 682163007803 Date of issue: 05/07/2016
c) Mobile No: 9876223488
State: UTTAR PRADESH Sub Caste type: Momin (Ansar, d) Alternate No: 9876223488
Ansari), Julah e) Email ID: [email protected]

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
HINDI
ENGLISH
MATH
X Regular SCIENCE 0363097 UP BOARD 2013 600.00 469.00 78.16
DRAWING
SOCIAL
SCIENCE
MECHANICAL
Diploma Regular ENGINEERIN GH6253 AMU 2016 5000.00 3956.00 79.12
G
c) Subject mentioned on EQR: TOM SOM MACHINE DESIG PRODUCTION TECHNOLOGY
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 Likely Date of Completion
B.E 31/05/2019 NA NA
13. a) Details of Application Fee of Rs. 100/- Paid (If not exempted as per Govt. rules)

Payment Method Fee Amount Payment Date Payment ID Transaction ID Status

APTC0026002520180 201808121112128001
UPI 100.00 12/08/2018 TXN_SUCCESS
812231116 10168033933706303
14. Physical Measurements:
a) Height (cm): 152.40 b) Weight(kg): 63.00 c) Visible Identification Mark: MOLE ON RIGHT PALM
15. Special Categories (if any) :
a) Do you belong to Minority community: YES [ ] NO [ ]
If YES, Community name : Muslim
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
Prefer
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
ence
Locatio
n
D2 D1 A1 K1 H2 B2 P2 P1 C2 A2 J1 N1 V1 B1 A3 K2
(City
Code)
17.List of Documents Uploaded
10th class or equivalent Certificate , Caste Certificate , EQR 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 IRSHAD ANSARI son/daughter of FAHIMUDDIN ANSARI 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: 901160017610 , Generated on 12/08/2018 23:14 hrs