ON-LINE APPLICATION FOR TNPSC REGISTRATION

35030
Registration # : 341330579
Full Name : K PATCHAIMAL
One Time ID : 13167417
Name of The Post Applying for :
Combined Civil Services Exam - II
(Group II) - (Interview - Posts)

Are you a Destitute Widow? : NA
Are you a Differently Abled Person? : NO
Are you an Ex-Serviceman ? : NO
PPO No : --
Date of Discharge / Probable date of Discharge : --
Are you a Government Employee? : NO
Nationality / Citizenship : Indian
Application Fee / Intimation Charges details:
Payment Mode: NO FEE
Amount : 0.00
Personal Details :
Date of Birth : 02/10/1989
Gender : MALE
Married : No
Religion : Hindu
Candidate's Place of Birth : TUTICORIN
Native District : Tuticorin
Father's Name : S KARUPPASAMY
Father's Place of Birth : Tuticorin
Mother Tongue : Tamil
Mother's Name : K SENTHOORKANI
Communal Category : Backward Class(BC)
Name of the SubCaste :
Nadar/Shanar and Gramani incl. Christian Nadar/Christian Shanar and Christian
Gramani
Certificate No : 4745264
Date Of Issue : 06/08/2004
Issuing Authority : Zonal Deputy Tahsildar
Taluk : Thoothukudi
District : Tuticorin
Address for Correspondence : 2A/198 MIDDLE STREET
MADATHUR
District Tuticorin
State : Tamil Nadu
Pin : 628008
Permanent Address : 2A/198 MIDDLE STREET
MADATHUR
District Tuticorin
State : Tamil Nadu
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Pin : 628008
Contact Details :
Email ID : patchai.1989@gmail.com
Mobile No : 8056364962
EDUCATIONAL QUALIFICATION PARTICULARS :
Exam Passed Date of
Publication of
Results
Medium of
Instruction
Degree Major Subject Board / University
S.S.L.C : 04/06/2005 English N/A N/A MATRICULATION
H.S.C or Equivalent
Qualification :
14/05/2007
English H.S.C
N/A
STATE BOARD
Degree : 20/05/2011 English B.E. ELECTRICAL ANNA UNIVERSITY
Others : --
Do you claim reservation for Persons Studied in Tamil Medium (PSTM)? : No
Details regarding the prescribed qualification :
Qualification Details : Any Degree
Other Equivalent Qualification Details : --
Certificate No : 2141
Year of Passing : 2011
Name of the Authority/ University : ANNA UNIVERSITY
Do you have the preferential qualification as per notification? : No
Physical Standards as per notification : Yes
Type writing
English Tamil
Type Writing -- --
Name of the Examination Centre District: Thoothukkudi
Name of the Examination Centre : Thoothukkudi
Optional Subject (As per Notification) : General Studies (Degree Standard) with General Tamil (S.S.L.C Standard)
Do you claim Age Concession? : No
Do You Claim Fee Exemption? : Yes
Under What Category? : Backward Class/Backward Class (Muslims)
No of free Attempts : 1
Criminal Case (Registered/Pending/Punishment awarded) : Not Applicable
Participation in Political Activities (In agitation/As a Member of Political
Organisation/Candidature in Election) :
Not Applicable
Post Qualification work experience (Start from present Employer) :
Name of the Organisation Designation From(mm/yyyy) To(mm/yyyy) Nature of Duty
Previous appearance for Oral Test / Written Test
Name of the Post Register No. Year
-- -- --
-- -- --

DECLARATION:

1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or
incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC.

2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

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5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I Certify that I have not been debarred / disqualified by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration
Place:
Date: 2013-09-24 18:52:58 Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference


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