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4/23/2014 Untitled Document
http://nausena-bharti.nic.in/th_multiqual_officer.php?applicationno=Quz53HZy0RHZy0R0A23M0A09TPS09T36P127Yup60A23M0A23M7Yup67Yup6XQp69 1/1
APPLICATIO N FO RM FO R Permanent Commission (PC)Logistics Dec 14 BATCH
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(UNMARRIED MALE/ FEMALE CANDIDATES O NLY)
FO R INDIAN NAVY O FFICE USE O NLY
CO DENO .
VALIDITY STATUS APPLICATIO N NO -PGG1430511557
Valid Invalid
1. CHOICE OF ENTRY- [1] PC(LOG)
2. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:-
NAME VATTIKUNTA ARUN KUMAR NATIONALITY: INDIAN
FATHER'S NAME V LAKSHMIPATHI NAIDU FATHER'S OCCUPATION/DESIGNATION:FO RMER
DATE OF BIRTH 1992/07/19 DOMICILE: Andhra Pradesh
GENDER M MARITIAL STATUS:Unmarried
7. ADDRESS: CORRESPONDENCE ADDRESS PERMANENT ADDRESS
ADDRESS 6-44 KAMMAPALLI PULICHERLA 6-44 KAMMAPALLI PULICHERLA
DISTRICT CHITTO O R CHITTO O R
STATE Andhra Pradesh Andhra Pradesh
PINCODE 517172 517172
TELEPHONE 0877 - 2444444 0877 - 2444444
MOBILE 9494831614 --NA--
EMAIL [email protected] --NA--
8.EDUCATION PARTICULARS:
8(a).Qual/Stream/YOP: B.Tech / Computer
Science / 2013Percentage 67.67%
Maximum Marks Marks O btained Maximum Marks Marks O btained
1st Semester 0 0 2nd Semester 1000 651
3rd Semester 750 483 4th Semester 750 502
5th Semester 750 517 6th Semester 750 518
7th Semester 750 515 8th Semester 650 468
9. I HAVE NOT ATTENDED ANY SSB TILL TO DATE WITH THE ARMY/NAVY OR THE AIR FORCE.
10.Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and
obtain NOC from the present employer.) Fill NA if not applicable:NA
DECLARATION1.I, hereby declare that I am unmarried male/female, governed by nationality condition as laid down by the Government of India and have neverbeen debarred from appearing at any examination. I have never been arrested/prosecuted and convicted by a criminal court or involved in any othercase registered by the Police.2. 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.3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me.4.Eligibility criteria will be verified on reporting at the selection centres. If found ineligible, I understand that criminal proceedings can be initiatedagainst me for fraudulent entry and falsification of GOI documents. I also accept that no TA/DA will be admissible to me in such cases.5. I have completed my B.Tech as on date.
Note: Please forward complete printout of this application duly signed to the address mentioned in the advertisement along with the relevantdocuments as per advertisement.
Place : ...................... Date: ..................Signature of Applicant:
.....................................April 23, 2014, 5:59 pm