KARNATAKA STATE POLICE DEPARTMENT

APPLICATION FOR THE POST OF SPL.RPC-KSRP (MEN) & PC(IRB)(MEN)-2016

P.J.Dg.. j Pm (g) v Pm (LDg) (g) zU Cf - 2016
Notification No /CZ

Application No :

9406855

AS

: 10/Pw-4/2016-17 AP: 27/07/2016

Applying as a : Direct Candidate

Name of the Battalion :

Total No of Posts: 597

5th Battalion Mysuru

01.

Applicant's Full Name

Cfzg t g

: HARIPRASAD H R

02.

Mother's Name
vAi g

: JAYAMMA

03.

Father's Name
vAzAi g

: RAJU

05.

Address

: #992,BANNI STREET,HUNSUR,HUNSUR,MYSORE,KARNATAKA,Pin Code :571105

08.

Email Id
E-

: hariprasad.agastya@gmail.com

09.

Mobile No
AS.

: 9902155340

10.

Native District
Av f

: Mysore

10a.

If Others
Evg

: Nil

11.

Height of the Candidate

CsyAi Jvg

: 170

11.

Weight of the Candidate

: Nil

: SC

12a.

Sub Caste
Gew

: ADI KARNATAKA

13a.

Death while in service

Pv U gt
Azg.

: Nil

13b.

Permanently disabled while in

Service

: Nil

04.

Gender
AU

CsyAi vP

: Male

Reservation Details
12.

Category
U

12b. Certificate Issue Date

: 21 Mar 2014

13.

: No

it v vgt AP

Only for Ex-servicemen Children (

For children of Ex-servicemen
Permanently disabled or died in
action)
if P PU iv (Pvz
vV zP Pv Cx gt
Az Pg PU)

Pv U v Pv
Azg
13c.

Relationship
AAzs

: Nil

13d.

Date of issue of Dependent Certificate

CAv it v vgu AP

14.

Are you claiming PDP Reservation ?

Aid gv Csy w
Pgg ?

: No

14a.

Date of issue of Certificate

it v vgu AP

: N/A

15.

Are you claiming Kannada medium

Reservation ?
Pq izs Csy w
Pgg ?

: Yes

15a.

Date of issue of Certificate

it v vgu AP

: 19 Feb 2013

16.

Are you claiming Rural Reservation? : No

Ut izs Csy w
Pgg ?

16a.

Date of issue of Certificate

it v vgu AP

: N/A

Date

04-Oct-2016 12:59:34 PM

: Nil

1/2

IP

117.221.11.24

17.

Are you a candidate belonging to

Hyderabad-Karnataka Region ?
zgz-PlP zz
CsyAi

: No

17a.

If yes, to which District you belong : N/A

to ?
zz, Aii fU AAg

19.

Are you a Govt. Employee ?

Pj Pgg?

: No

19a.

Department
ES

: N/A

19b.

Designation
z

N/A

19c.

Years of Service
z

: N/A

19d.

NOC issue Date

J.N.., vgt AP

: N/A

20.

Date of Birth
nz AP

: 02 Feb 1990

20a.

Age,As on date (31.08.2016)

: 26 Years 6 Months 29 Days Gender

Male Applied As Direct Candidate
Category SC

No

21a.

Give details
g qz

: Nil

: No

22a.

Give details
g qz

: Nil

21.

Have you been involved in any

:
Criminal Case / Department Enquiry?
Aiizzg Cgzs Pgtz /
ES ZguAi
zAiiVg zVz g

22.

Have you been convicted in a

criminal case ? / Cgzs

PzAi PU
Mngg ?

QUALIFICATION DETAILS
: No

23.

Are you holder of PUC or Equivalent Qualification ?

Ai Cx vvi zv Agg?

23a.

Educational Qualification
zv

: SSLC - STATE BOARD

23b.

If Equivalent, Please specify

vvi zv Azg
.

: Nil

23c.

Year of Passing
Gwtgz

: 2006

23e.

Secured Marks
Uz CAPU

: 414

24d.

Maximum Marks
Uj CAPU

: 625

23f.

Percentage
Pqg

: 66.24

BANK PAYMENT DETAILS

24.

Date of Challan Generation

Z fz AP

: 27 Aug 2016

24a.

Fee Paid
wz

: 100

24b.

Date of Fee Payment

AzAi irz AP

: 29 Aug 2016

24c.

Journal No.
d AS

: 1784629

24d.

Bank
AP

: SBM

24e.

Bank Branch Code

AP AZ Pq

: 41131

24f.

Bank Address
AP

: N/A

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Candidate's Signature /CsyAi

Date

04-Oct-2016 12:59:34 PM

2/2

IP

117.221.11.24