APPLICATION FORM FOR Short Service Commission Executive{GS(X)} Jan-12 BATCHPaste your recent

colour photograph
(Do not staple)(UNMARRIED MALE CANDIDATES ONLY)
FOR INDIAN NAVY OFFICE USE ONLY
CODE NO. VALIDITY STATUS ONLINE ROLL NO.
Vaild Invaild SGX12100048
1.PRIORITY CADRE:

Executive Branch(General Service) Executive Branch (Hydro Cadre)2. PERSONAL PARTICULARS AS IN

MATRICULATION CERTIFICATE:-
NAME Varun Gupta
FATHER'S NAME Suman Gupta
DATE OF BIRTH 19/12/1988

3.FATHER'S OCCUPATION/DESIGNATION:Shopkeeper
5.DOMICILE: Himachal 6.MARITIAL
4.NATIONALITY: INDIAN
Pradesh STATUS:Unmarried
7. ADDRESS:
PERMANENT PRESENT
ADDRESS v.p.o. parour v.p.o. parour
DISTRICT kangra kangra
STATE Himachal Pradesh Himachal Pradesh
PINCODE 176064 176064
TELEPHONE 01894 - 240389 01894 - 240389
MOBILE --NA-- 9418310526
EMAIL --NA-- varun_090@hotmail.co.in
8.EDUCATION PARTICULARS:8(a).QUALIFICATION: B.Sc (Physics and Maths)8(b).STREAM: Physics &
Maths8(c).YEAR OF EXAM PASSED: 20098(d).PERCENTAGE: 64.7%
Maximum Marks Marks Obtained
1st Year 750 505
2nd Year 650 360
3rd Year 600 429
9.NAME AND ADDRESS OF COLLEGE WHERE STUDIED :M.C.M. D.A.V. College Kangra10.NAME OF
UNIVERSITY TO WHICH COLLEGE AFFILIATED AND ADDRESS:Himachal Pradesh University Shimla11. I HAVE
NOT ATTEND ANY SSB TILL TO DATE WITH THE ARMY/NAVY OR THE AIR FORCE.

DECLARATION
1.I, hereby declare that I am unmarried male/female, governed by nationality condition as laid down by the Government of India and have
never been debarred from appearing at any examination. I have never been arrested/prosecuted and convicted by a criminal court or involved in
any other case registered by the Police.
2. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief.
3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.

Place : .............................. Signature: ..............................................

Date : .............................. Name of Applicant: ..............................
March 12, 2011, 8:05 pm