HIMACHAL PRADESH PUBLIC SERVICE COMMISSION

CDPO & Tehsil Welfare Officer - 2013 Application No :

159977

1. 2. 3. 4.

Applicant's Name : Father's Name : Date of Birth : Category:

Rajni Bala Pooni Kuldeep Singh 17/11/1985 General - (01)

5. Sex : 7. Phone No. :

9. Correspondance Address :

Female 01975203313

6. State to which belongs: 8. Mobile No. :

Himachal Pradesh 8091426324

W/O Antaryami Singh , V.P.O. Rainsari , Teh Una, , Una, Himachal Pradesh, Pin:174303

10. Permanent Address :

W/O Antaryami Singh , V.P.O. Rainsari , Teh Una, , Una, Himachal Pradesh, Pin:174303

11. H.P.Govt.Servant :
13. Exam/Test Station

No
Una

12. Age Relaxation :

No

14. Academic Qualification :

S.No 1 2 3 4 5 Qualifaction Matric Plus 2/Equivalent Bachelor's Degree MATER DEGREE Board/ University CBSE CBSE HPU GNDU Subjects Science, Maths, SST Physics Chemistry, Maths Physics Chemistry, Maths Physics Physics Nanotechnology ii. Transaction ID : iv. Fee :
% of Year Marks

71.4 2000 60.6 2002 65.94 2005 60 72 2008 2009

M.Phil LPU 15. Examination/Test Fee Details : i. Registration ID 11371013129678 iii. Branch Code : v. Date of Deposit : 011000 07/11/2013

M784013 400

DECLARATION
I hereby declare that I am an Indian National and the statements made in this application are true, complete and correct to the best of my knowledge and belief. I undertake that in the event of any information being found false or incorrect at any stage, my candidature is liable to be cancelled and if appointed, appointment itself shall be liable to be cancelled. I also solemnly declare that I do not suffer from any of the disqualifications shown in the advertisement for the post and I am eligible in all respects according to eligibility criteria prescribed.

Appl. Date :01/11/2013

Signature of the Applicant