Public Service Commission U.P.

, PRAYAGRAJ
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Detailed Application Form ( विस्तृत आवेदन पत्र )

Notification Details ( Direct Recruitment )

Advertisement Number : D-4/E-1/2023

Department/Directorate Name : UTTAR PRADESH AYUSH (HOMOEOPATHY) DEPARTMENT

Applied for Post : HOMOEOPATHIC MEDICAL OFFICER, S-11/08

Type of Recruitment : GENERAL RECTT.

Candidate's Personal Details

OTR Number : 783904405406 Application ID : 009190549000082

Candidate's Name : ANKUR GUPTA Father's/Husband's Name : SANTOSH KUMAR

Mother's Name : SANGEETA DEVI Gender : Male
Date of Birth : 21/05/1998 Domicile of UP : Yes
Home State : UTTAR PRADESH Home District : DEORIA
Category : OBC Marital Status Single
Mobile Number : XXX-XXX-1138 Email-ID : ****[email protected]

Bank Transaction Details

Payment Gateway : State Bank Of India Payment Mode : INB
Fee Amount : Rs. 105.00 Transaction ID - Date: CPADELJSW1 - 18/10/2023

Candidate's Other Details :

Are you Dependent of UP
No Are You Skilled Player of UP? : No
Freedom Fighter?
Are You Extra Ordinary Player
No Level of Player : ---
of UP?
Service Duration (Day-Month-
Are you UP Ex. Army? No 0-0-0
Year) :
Retirement Are you ECO/SSCO/CO of
// No
Date(Date/Month/Year) : Army ?
Have your services been
Have you completed 5 year extended for rehabilitation and
No No
service ? no disciplinary action is
pending against you ?
Are You Physically
A). Are you Blind or Have
Handicapped (Divyangjan) of No No
Vision problem? :
Uttar Pradesh?
C). Have you any Physical
B). Are you Deaf or Have
No Problem (Locomoter disability No
hearing problem? :
or Cerebral Palsy)? :
D). Have you any Neurological
E). Have you Multiple Disabilities? : No
Problem? : No
Are You State Govt. Employee Service Duration (Day-Month-
No 0-0-0
of Uttar Pradesh ? : Year) :
Have you ever been Debarred Completion Date of Debarment
No N/A
from UPPSC ?: (DD/MM/YYYY) :
Basic Academic Qualification Details :

S No Examination Passed Board Name Year Of Passing Roll Number

UTTAR PRADESH BOARD OF HIGH SCHOOL AND
1. High School 2013 2884988
INTERMEDIATE EDUCATION

Essential Qualification Details

Evalation Type
Year Of Passing
Obtained Marks
Sr. No. Qualification AffirmationUniversity/Institute Cert/Roll Number
Total Mark
Issue Date
Percentage
A recognized Degree in
Homoeopathy, the duration of
study of which is not less than 5
N/A
years according to its syllabus or
N/A
1. course or A recognized Diploma Yes ---
N/A
in Homoeopathy, the duration of N/A
N/A
study of which is not less than 4
years according to its syllabus or
course
The applicant should be duly N/A
registered with the N/A
2. Yes ---
Homoeopathic Medicine Board, N/A
N/A
Uttar Pradesh N/A

Preferential Qualification Details

Sr. No. Qualification Acquired
1. Served in the territorial army for a minimum period of two years. No
2. Obtained a B Certificate of National Cadet Corps, No

Candidate's Permanent & Communication Address Details :

Permanent Address Correspondence/Mailing Address
NEAR KALI MANDIRDEORIA SHARDA HOMEO HALLANSARI
Address (Line 1 2 3) : Address (Line 1 2 3) :
KHASDEORIA ROAD PUNJABI GALIDEORIA
House No. : NA House No. : NA
Street No./PO : DEORIA Street No./PO : DEORIA
City Name : DEORIA City Name : DEORIA
State : UTTAR PRADESH State : UTTAR PRADESH
District Name : DEORIA District Name : DEORIA
PIN : 274001 PIN : 274001

I accept the following declaration : :Yes

1. I hereby declare that I have read all terms & conditions according to the advertisement and I accept it.
2. 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.
3. I under take that if any information furnished or documents submitted by me are found to be false or have been concealed, then my application/candidature is liable to
be rejected/cancelled by UPPSC.
Accepted : Application form has been Provisionally accepted.
Application Form Submission Date : 18/10/2023 , Time : 15:12:37 Application Form printing Date & Time : [ 18/10/2023 ,15:12:40 ]