Вы находитесь на странице: 1из 2

Uttar Pradesh Police Recruitment and Promotion Board, Lucknow

उ तर दे श पु लस भत एवं ो न त बोड, लखनऊ

I Declare that I have Read the detailed User Manual & Notification.

Notification Details ( Examination )

Advertisement/Notification Number : PRPB-ONE-1(112)/2017 /

Department/Post Name :
Police and Constable PAC Direct Recruitment 2018
Application ID : 009197105035575
Registration No. : 10513349664
Candidate's Personal Details
Mother's Name : MEENA DEVI Citizenship : Citizen of India
Gender - Date of Birth : Male -02/04/1994 Domicile of UP? / Category : Yes /OBC
I agree to use my aadhaar number to authenticate
Are you Married ? : No Aadhaar(UID) Number (Optional): my identity from UIDAI.My identity information
would only be used for e-KYC verification for the
purpose of authentication.

Mobile Number/ Email-ID : 8009279311 /bnand1998@gmail.com

Candidate Domicile Certificate Details (If you are domicile of Uttar Pradesh you are required to produce domicile certificate at the time of document verification to claim any reservation/ relaxation

A (i) Domicile Certificate Issuing UP State

A (ii) Date of Issuing Domicile Certificate (DD/MM/YYYY) 06/02/2018
A (iii) Domicile Certificate Serial No : 672182005884
Candidate Category (OBC/SC/ST) Certificate Details
B (i) Category Certificate Issuing UP State authority TEHSILDAR
B (ii) Date of Issuing Category Certificate (DD/MM/YYYY) 04/02/2018
B (iii) Category Certificate Serial No : 672183008205
Bank Transaction Details
Rs. 400.00 , CPD3481345 -18/02/2018
Bank Name - Payment Mode : State Bank Of India - INB Fees, Transaction ID - Date:
Other Details of Candidate
Have you served as UP Home Guard for a minimum period
Dependent of Freedom Fighter? No No
of 03 years and having required certificate?
Ex. Service Man? No Service Duration for Ex-service man (Day-Month-Year) : 0 - 0 - 0
Retirement Date for Ex-service Are you a U P Government Employee and having required
// No
man (Date/Month/Year) : certificate:
Service Duration for Government employee (Day-Month-
0 0 0
Year) :

Educational Qualification
Name of Board/ Year Of Roll
Name of Examination Acquired(Y/N)
Institute/University Passing Number
1 10th standard by board established by law in India or a UTTAR PRADESH BOARD OF HIGH SCHOOL
Yes 2009 3119705
qualification recognized by the government as equivalent thereto AND INTERMEDIATE EDUCATION
2 12th standard by a Board established by law in India or a UTTAR PRADESH BOARD OF HIGH SCHOOL
Yes 2011 1995115
qualification recognized by the Government as equivalent thereto. AND INTERMEDIATE EDUCATION
Preferential Qualifications:-
Preferential Qualification Details
Qualification Acquired
1 Obtained O LEVEL Certificate in Computer from DOEACC or NIELIT Society No
2 Served in the Territorial Army for a minimum period of two years No
3 Obtained a B certificate of National Cadet Corps No
Home District VARANASI
Order of Post Preference 1-Constable Civil Police 2-Constable PAC
“Candidates will be considered only for those posts for which he has applied and given preference”

↓ Address Details ↓ Candidate's Permanent Address Candidate's Correspondence/Mailing Address

Locality/ Kasba/City: VARANASI VARANASI
PIN : 221007 221007

घोषणा Declaration
1. म एत वारा घोषणा करता हूं क मने पर ा हे तु नगत व तत
ृ सूचना/ व ि त जो क वेबसाइट http://prpb.gov.in पर उपल ध है , म उि ल खत सभी ावधान को यान से पढ़ लया है तथा उन ावधान का
पालन करने का वचन दे ता/दे ती हूँ ।

I hereby declare that I have read all the provisions in the detailed notice/notification available on website http://prpb.gov.in of the examination carefully and hereby undertake to abide by them.

2. म घोषणा करता हूँ क म रा यता, आयु सीमा, शै क यो यता इ या द क यथा न द ट पा ता क सभी शत को पूण करता/करती हूँ ।
I declare that I fulfil all the conditions of eligibility regarding nationality, age limits, educational qualifications etc. as prescribed.

3. म घोषणा करता/करती हूँ क अनुसू चत जा त / अनुसू चत जनजा त के उ मीदवार के प म आर ण के लए मेरा दावा स य एवं सह है तथा म सूचना/ व ि ते म दए गए ा प म जा त माण प धा रत
करता/करती हूँ ।
I declare that my claim for reservation as SC /ST candidate is true and correct and I am in possession of caste certificate in the prescribed format given in the notice/notification .
म घोषणा करता/करती हूँ क ओबीसी उ मीदवार के प म आर ण के लए मेरा दावा वा त वक एवं सह है तथा म सूचना/ व ि त म दए गए ा प म जा त माण प जो दनांक 01/04/2017 के बाद का नगत
है ,धा रत करता/करती हूँ । म यह भी घोषणा करता हॅू क म उ0 0 सरकार वारा नगत आदे श सं या 13/22/16/92/TC-iii-का-2/2014 दनांक 17.12.2014 म व ण त ओबीसी ेणी के मी लेयर (creamy layer)से
संबं धत वग से नह ं हूँ ।
I declare that my claim for reservation as OBC candidate is true and correct and I am in possession of caste certificate which is issued after 01/04/2017 in the prescribed format given in the
notice/notification. I also declare that as per Govt. order No.13/22/16/92/TC-iii-का-2/2014 dated 17.12.2014, I do not belong to the category(creamy layer) mentioned therein.

4. म यह घोषणा करता हूँ क (शाद शुदा पु ष अ यथ हे तु) मेर एक से अ धक जी वत प नी नह ं है या (शाद शुदा म हला अ यथ हे तु) म यह धोषणा करती हूँ क मने कसी ऐसे पु ष से शाद नह ं क है िजसक पहले
से ह एक जी वत प नी है ।
I declare that I have no more than one wife living (For Married Male) OR I declare that I have not married a man already having a living wife (For Married Female).

5. म यह भी घोषणा करता/करती हूँ क मुझे व ध वारा था पत कसी भी यायालय के वारा कभी भी दोषी नह ं ठहराया गया है ।
I also declare that I have never been convicted by any court of law.

6. म यह भी घोषणा करता/करती हूँ क मुझे सरकार सेवा से कभी भी बखा त अथवा हटाया नह ं गया है तथा न ह प रवी ा अव ध के दौरान मेर सेवाओ को समा त कया गया है ।
I further declare that I have never been dismissed or removed from Govt. Service or my service been terminated during probation.

7. म एत वारा घोषणा करता/करती हूँ क इस आवेदन प म क गयीं सम त वि टयां / कथन मेरे ान और व वास के अनुसार वा त वक, पूण और सह ह तथा मै नधा रत नयम /अ धसूचना के अनुसार पा ता
के सभी मानदं ड को पूरा करता /करती हूँ| कसी भी सूचना के झूठा या गलत पाये जाने अथवा अपा ता क ि थ त म, मेरे चयन से पूव या चयन के उपरा त कभी भी नयम के अनुसार बोड मेरे व कारवाई कर
सकता है , य द यह पता चलता है क मने कसी भी मु े पर बोड या नयुिि त ा धकार को गुमराह कया है , तो इसके लये म पूर तरह से वयं िज मेदार होऊँगा िजसम अ य द डा मक कायवाह के साथ व धक
कायवाह भी सि म लत होगी तथा उसके प रणम व प सभी दं ड का भागी होऊँगा ।
I hereby declare that all the entries/statements made in this application are true, complete and correct to the best of my knowledge and belief and I fulfill the eligibility criteria as per the relevant
rules/notification. In the event of any information being found false or incorrect or ineligibility being detected before or after selection the Board or appointing authority can take action against me as
per rules in case it is detected that I have mislead the Board on any issue and I will be solely responsible for all penal consequences thereof, including but not limited to penal action under the law.

I accept the above declaration : Yes

↓ Current status of application ↓

Your application is under processing.
Application Form Submission Date and Time : DATE :18/02/2018 ,TIME :15:55:27 IP Address:
The application form has been updated /modified on Date: 18/02/2018
Application Form printing Date & Time : [ 18/02/2018 ,6:46:43 PM ]