150344260919150344260919Office Use Office Use Office Use Registration No

15034426091
1.Candidate Name SUSHIL KUMAR
TYAGI
2.Parent Name ASHOK KUMAR 3.Nationality Indian
4.Date Of Birth 15-11-1997 5.Marital Status Un Married 6.Qualification
7.Intermediate/Voca
tional/Diploma
English %
66 8.Name of
Intermediate/vocatio
nal/Diploma
UP Board of
Higher School &
Intermediate
Education
9.Matric Board UP Board of
Higher School &
Intermediate
Education
10.Matric Roll No 0085386 11.Aggregate 67 12.Mobile No 8650862283
13.EMail Id sushiltyagi562@gm
ail.com
14.SOAFP No 15.Discharged from
Forces
No
16.Stream Applied Group-XY 17.Identification
mark
A 18.Candidate Height 170cm
19.Exam Center
Choice 1
2 ASC New Delhi 20.Exam Center
Choice 2
6 ASC Mumbai 21.Exam Center
Choice 3
5 ASC Jodhpur
22.Permanent
Address
47,beri,purakanera
,Agra,Uttar
Pradesh,283113,
23.Communication
Address
47,beri,purakanera
,Agra,Uttar
Pradesh,283113,
24.Preference for
group XY candidate
only
1st preference: X
2nd preference: Y
DECLARATION BY THE CANDIDATE
I hereby declare that all statements made in this application are correct.I unde
rstand that I am
liable to be disqualified at any stage, if the information given is found to be
incorrect/incomplete/false. I undertake to produce all original certificates and
statement of marks
and three photocopies of each, duly attested by a Gazetted Officer, at the time
of appearing in the
Selection test. I am willing to undergo physical and medical test, at my own ris

k and will not be

entitled for compensation for injuries if any, sustained during such test. I am
aware that the
decision by President, CASB will be final and binding on me.
Shirt Size:
cm
Shoe Size(BATA):
Waist Size:
Inch
Signature of the candidate
Signature of parent/guardian
(If candiddate below 18 yrs on the day of filling application)
Name(Gaurdian if applicable ) :
Place:
Date:
Paste your
photograph
Left Hand Thumb
impression
----------------------------------------------Tear off and Paste on Envelope------------------- -----------------------Tear of
f and Paste on Envelope------------------To,
President
Central Airmen Selection Board
PO Box: 11807
New Delhi-110010
15034426091
Group-XY
67
150344260919150344260919Office Use Office Use Office Use Registration No
15034426091
1.Candidate Name SUSHIL KUMAR
TYAGI
2.Parent Name ASHOK KUMAR 3.Nationality Indian
4.Date Of Birth 15-11-1997 5.Marital Status Un Married 6.Qualification
7.Intermediate/Voca
tional/Diploma
English %
66 8.Name of
Intermediate/vocatio
nal/Diploma
UP Board of
Higher School &
Intermediate
Education
9.Matric Board UP Board of
Higher School &
Intermediate
Education
10.Matric Roll No 0085386 11.Aggregate 67 12.Mobile No 8650862283
13.EMail Id sushiltyagi562@gm
ail.com
14.SOAFP No 15.Discharged from
Forces
No

16.Stream Applied Group-XY 17.Identification

mark
A 18.Candidate Height 170cm
19.Exam Center
Choice 1
2 ASC New Delhi 20.Exam Center
Choice 2
6 ASC Mumbai 21.Exam Center
Choice 3
5 ASC Jodhpur
22.Permanent
Address
47,beri,purakanera
,Agra,Uttar
Pradesh,283113,
23.Communication
Address
47,beri,purakanera
,Agra,Uttar
Pradesh,283113,
24.Preference for
group XY candidate
only
1st preference: X
2nd preference: Y
DECLARATION BY THE CANDIDATE
I hereby declare that all statements made in this application are correct.I unde
rstand that I am
liable to be disqualified at any stage, if the information given is found to be
incorrect/incomplete/false. I undertake to produce all original certificates and
statement of marks
and three photocopies of each, duly attested by a Gazetted Officer, at the time
of appearing in the
Selection test. I am willing to undergo physical and medical test, at my own ris
k and will not be
entitled for compensation for injuries if any, sustained during such test. I am
aware that the
decision by President, CASB will be final and binding on me.
Shirt Size:
cm
Shoe Size(BATA):
Waist Size:
Inch
Signature of the candidate
Signature of parent/guardian
(If candiddate below 18 yrs on the day of filling application)
Name(Gaurdian if applicable ) :
Place:
Date:
Paste your
photograph
Left Hand Thumb
impression
----------------------------------------------Tear off and Paste on Envelope------------------- -----------------------Tear of

f and Paste on Envelope------------------To,

President
Central Airmen Selection Board
PO Box: 11807
New Delhi-110010
15034426091
Group-XY
67