Application of Job: AGNIVEER [SSR-F] - 01/2022
Application No: SSRF22112021904N Application Date: 22/07/2022
PRIORITY
1. AGNIVEER [SSR-F] 01/2022
PERSONAL PARTICULARS
Name: VANI DHOTE
Father's/Mother's Name: SAHEBRAO DHOTE
Guardian's Name:
Nationality: INDIAN
Identification Mark 1: MOLE ON RIGHT HAND
Identification Mark 2: ---------
Date of Birth: 31/05/2003
Aadhaar Number:
4992
(Last 4 digit)
PAN Number: ---------
Voter ID Number: ---------
Passport Number: ---------
Ration Card Number: ---------
EDUCATION PARTICULARS
Details of 12th Science
Subjects Total Marks Obtained Marks
Physics 100 82
Chemistry 100 87
Maths 100 60
Total Marks: 300 Marksheet Serial Number: 0527528
Obtained Marks: 229 State Conduct: MADHYA PRADESH
Percentage: 76.33 Board Conduct: State Board
Details of 10th
Total Marks: 500 Marksheet Serial Number: 0775254
Obtained Marks: 430 State Conduct: MADHYA PRADESH
Percentage: 86.00 Board Conduct: State Board
MILITARY RECORD
Have you ever been enrolled in
NO
Armed Forces before?:
Have you been
discharged from
NO
Armed forces
before?:
COMMUNICATION PARTICULARS
Details of Permanent Address
IN FRONT OF BETUL
Address 1: Address 2: RANIPUR ROAD GOUTHANA
FRACTURE HOSPITAL
State: MADHYA PRADESH District: BETUL Pincode: 460001
Domicile: MADHYA PRADESH Phone No.: 7000794255 Mobile No.: 7000794255
Email id: [email protected] Alternate Email id: ---------
Details of Correspondence Address
Same as Permanent Address
Alternate Mobile Number: ---------
A. I hereby declare that I am unmarried, governed by nationality condition as laid down by the Government of India and
have never been debarred from appearing at any examination. I have never been arrested/ prosecuted and convicted by a
criminal court or involved in any other case registered by the Police.
B. I hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my
knowledge and belief.
C. I fully understand that in the event of my information being found false or incorrect, appropriate action can be taken
against me.
D. Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal
proceedings can be initiated against me for fraudulent entry and falsification of Government of India documents. I also
accept that no TA/ DA will be admissible to me in such cases.
