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Application Form
Advt. No. CEPTAM-09/ Crucial date of Eligibility :- 15/10/2019
A&A
For Office Use Only

Online Application 904010203872

Number:
Final Submitted On: 26-09-2019 22:13

8. Nationality: INDIAN

1. Post Code & Post Name: 9. Identity Proof ID Type: ID Number: 4691 8678 2834
A&A [0401-Administrative Assistant 'A' (English Typing)] Aadhaar Card

2. Exam City Preference: 16-HYDERABAD ,42-VIJAYAWADA , 10. Gender: Male

05-BENGALURU
Person With Disability(PWD)
3. Candidate’s Name: B LAKSHMIKANTH
Type : NA
4. Father's Name: B NAGESH
% of disability : NA
5. Mother's Name: B ANURADHA
Cetificate No. : NA
6. Date of Birth: 19-07-1990
Date of Issue : NA
Age as on Crucial Date:29Y,2M,26D
Do you belong to orthopedically handicapped (afflicted by cerebral palsy),
7.a) Category orthopedically handicapped (both arm affected), orthopedically
Unreserved(UR) Scheduled Caste(SC) handicapped candidates who has a locomotor disability where in the
Scheduled Tribe(ST) OBC(Creamy Layer) dominant writing extremity is affected to the extent of slowing down the
OBC(Non-Creamy Layer) performance of the candidate. : NA
Do you belong to Economically Weaker Sections (EWSs) as per DOPT
F.No.36039/1/2019-Estt.(Res.) dated 19th January, 2019 : NA Ex-Service man (ESM)
Date of Joining : NA Date of Discharge : NA
(If SC/ST/OBC-NCL/EWS)
State : TELANGANA Sub Caste : chippolu Service Rendered : NA

Certificate No : NA Have you already secured employment in civil side under Central Government
on regular basis after availing the benefits of reservation given to Ex-
Date Of Issue : NA
servicemen for re-employment? : NA

Government Servant(GS)
Meritorious Sports Person Sport Name : NA
Type of GS : NA Specify : NA
Sport Name Level : NA
Date of Joining : NA
Widow/Divorced Woman/Judicial Seperated Woman (Not
Ministry/Deptt./Estt. : NA
Remarried)

11. Contact Details :

a. Correspondence Address: 1-1-2/A/3 SAIPRIYA COLONY KAPRA ECIL HYDERABAD ,ECIL POST

District: Medchal City: HYDERABAD State: TELANGANA Pincode: 500062

if Permanent Address same as Correspondence Address:

b. Permanent Address : 1-1-2/A/3 SAIPRIYA COLONY KAPRA ECIL HYDERABAD ,ECIL POST

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District: Medchal City: HYDERABAD State: TELANGANA Pincode: 500062

c. Mobile No : +91-8686244033 d. Alternate No : 9398401457

e. Email ID : [email protected]

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12. Essential Educational Requirements

Qualifications Mode of Subjects Duration of Roll No. Institute/Board Year of Max.Marks / Marks/CGPA % of Marks
Qualification Course Passing CGPA Obtained Secured
(In Year)
10th Regular N.A NA 0995128 BOARD OF S 2005 600 474 79
ECONDARY
EDUCATION

12th Regular MPC 2 072864602 BOARD OF I 2007 1000 811 81.1

NTERMEDIA
TE EDUCATI
O

a) Additional Qualifications (Except above)

Qualification Name of Course Status Date of Passing/Likely date of

completion
Graduation B TECH Completed 17-08-2011

13. Application Fee of Rs. 100/- Paid (If not exempted as per Govt. rules)

Payment Methods Fee Amount Payment Date Payment ID Transaction ID Status

DC 100 2019-09- 9040102038722019092 201909261112128001101684690898688 Paid
26T22:26:27.397 6222434 81

14. Physical Measurements :

a) Height (cm): 160 b) Weight(kg): 55 c) Visible Identification Mark: A MOLE ON RIGHT HAND

15. Special Categories(if any):

a) Do you belong to Minority community: Yes No
b) Domiciled in J&k during 01/01/1980 to 31/12/1989: Yes No

16. List of Documents Uploaded

Age Proof & EER(10th or Equivalent), EER(12th or Equivalent)
I hereby give my consent to publish my score and rank of Tier-I Exam along with my particulars, on the website. Yes No
17. Declaration
I B LAKSHMIKANTH son/daughter of B NAGESH 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.
18. Required at the time of document verification, if shortlisted

Place:

Date: a) Left Hand Thumb Impression b) Signature of Candidate

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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: 904010203872, Final Submitted On: 26-09-2019 22:13

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