Application Form

Department of Revenue & Land Reforms, Govt. of Bihar

Application for Contractual Recruitment of Special Survey Clerk
Application Details
Application ID :     SSC/0047876 Application Date
Post Applied For : Special Survey Clerk
: 15-Mar-2019

Personal Details
Applicant Name ANUJ KUMAR YADAV
Father's /Husband's Name YOGENDRA KUMAR SINGH
Mother's Name Saroj Kumari
Date of Birth 01-Jun-1996
Age as on (01.01.2019) 22 Years 7 Months
Gender Male
Category GEN
Nationality Indian
Physically Handicapped No
Catagory of Physically
Handicapped
Percentage of Physically No
Handicapped
Grand Children of Freedom No
Fighter
Email ID annubidhuna@gmail.com
Mobile No. 8707690344
Phone With STD Code
Aadhar No XXXXXXXX6226
Identification Marks MOLE on the face

Address for Correspondence

Address Vill and Post Etaily Auraiya
Pin Code 206241

Permanent Address
Address Vill and Post Etaily Auraiya
Pin Code 206241
State of Domicile No
Home District

Educational Qualification
  Board/University Institute State Specialization Passing Marks Full Marks Marks
Type Year Obtained (Excluding Obtained
(Excluding Extra Subject)  (%)
Extra Subject)
I.Matric UP BOARD Private Uttar 2011 509 600 84.83
Pradesh
II.Intermediate UP BOARD Private Uttar Science 2013 458 500 91.6
Pradesh
III.Degree AKTU Private Uttar Science 2018 3580 5000 71.6
LUCKNOW Pradesh
IV.Post Private 0 0 0 0
Graduation
 Points
Total Point   72.34

I declare that all the above information is correct to the best of my knowledge and that I shall be liable for punishment if
information is found incorrect. I also declare that I have understood the guideline for engagement and will fully abide by
the same including any further guideline issued by Department of Revenue & Land Reform, Government of Bihar in this
regard. I categorically declare that there is no pending Criminal case or serious complaint against myself.

Place:-

Date:-
Signature of Applicant