Part-II: Details of Team Members: (up to 25 members)
1. Name Aditya Rana
2. Father’s Name Ombeer Rana
Hno-1030, Near sarvodaya hospital, sector-19,
3. Permanent Address old faridabad, faridabad, haryana, 121002
Hno-1030, Near sarvodaya hospital, sector-19,
4. Present Address old faridabad, faridabad, haryana, 121002
5. Mobile Number 9667528682
6. Citizenship In India Yes No
7. Education Qualifications
✔ Graduate Details
Dr APJ Abdul Kalam Technical University Btech in
Post Graduate Details
Doctoral Details
Post Doctoral Details
Any Others,detail may be given
8. Professional Qualifications & Certifications
Certified Appsec Practitioner
Detail may be given
9. Employed Yes No
10. Experience of Penetration Testing Yes No
More than 1 year
(Specify years or months, if any)
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OR
Ever worked as Professional Penetration Testers
Hobby Informal As an Intern Any Other
Brief about the Vulnerabilities/ Bugs reported/ discovered by the applicant : (Numbers of
11. Reported Vulnerabilities/ Bugs to Vulnerability Disclosure Plaftforms or organisations such as
NCIIPC, Bugcrowd, Hackerone, Intigriti, Synack red team, HackerProof, etc)
Yes No
I have submitted more than 300+ bugs on
If Yes, details may be given: different platforms
htt // b b t h t /h t / dit
12. Published CVEs/ CWEs (may mention link for reference)
Yes No
If Yes, details may be given:
13. Areas of reported Vulnerabilities/ bugs:
✔ Web Application Cloud
✔ API ✔ Mobile App
✔ Network IoT
DB Reverse Engineering
OS SCADA/ DCS
14. Honours and Awards (may mention link for reference)
Yes No
If Yes, details may be given: an award for finding good bugs during a pentest. Go
15. Repository of developed tools Example: Github/GitLab/Bitbucket/Sourceforge, etc
Yes No
If Yes, details may be given:
16. Preferred places (city) of participation in the exercises in order of preference
✔ Anywhere in India Specific Cities
Preferred months and number of days (may provide your availability for the next 12
17.
months)
April - December
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18. Aadhar Card No 608017497495
Please attach the following documents with this Form
a) Copy of your Aadhaar card Attached Not Attached
b) Scanned copy of the latest passport
Attached Not Attached
size photo
19. Passport Number (if available)
Date of Issue
Please attach the following documents with this Form
a) Copy of your Passport Card Attached Not Attached
20. Motivation for participating in the scheme
It was my dream of working with the government to join Cybercell and protect our nation from cyber thre
Security Questionnaire
Are you facing any criminal charges in
21. Yes No
any court?
If yes, detail may be given:
Have you ever been convicted on any
22. Yes No
crime?
If yes, detail may be given:
Are the any pending Warrants/
Summons for Appearance or has any
23. Yes No
Warrant of Arrest ever been issued to
you by any court?
If yes, detail may be given:
Has any court made any order
24. prohibiting your departure from Yes No
India?
If yes, detail may be given:
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Have you ever indulged or likely to
indulge in activities which are
prejudicial to the sovereignty and
25. integrity of India, the security of India, Yes No
friendly relations of India with any
foreign county or the interest of the
general public?
If yes, detail may be given:
✔ I certify that the information given above is true to the best of my knowledge.
Signature
**Note: Please ensure that the duly filled soft copy of the form along with scanned copy of ink signed form reaches
us as early possible but not later than 15 days of receipt of this email.
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