nausena bharti shashank

APPLICATION FORM FOR Short Service Commission - University Entry

Scheme(Engineering) Jun 14 BATCH

(UNMARRIED MALE CANDIDATES O NLY)

FOR INDIAN NAVY O FFICE USE O NLY

CODE

NO .VALIDITY STATUS APPLICATION NO-SUE143207991

Valid Invalid

1. CHOICE OF ENTRY- [3] SSC(UES-NA) [1] SSC(UES-ENG) [2] SSC(UES-SUBMARINE

ENGG)

2. P ERSONAL PART ICULARS AS IN MATRICULATION CERTIFICATE:-

 NAME GSHASHANK REDDY  NAT IONALITY: INDIAN

FATHER'S NAMEGGOVERDHAN

REDDY

FATHER'S OCCUPAT ION/DESIGNATION:SRASSISTANT

PHC

DATE OF BIRTH 1993/04/17 DOMICILE: Andhra Pradesh

GENDER  Male MARITIAL STATUS:Unmarried

7. ADDRESS: CORRESPONDENCE ADDRESS PERMANENT ADDRESS

ADDRESSFLAT NO 302 SHIVA SAI RESIDENCY

MEERPETSARO O RNAGAR 

FLAT NO 302 SHIVA SAI RESIDENCY

MEERPETSARO O RNAGAR 

DISTRICT HYDERABAD HYDERABAD

STATE Andhra Pradesh Andhra Pradesh

PINCODE 500097 500097

TELEPHONE 91 - 91 -

MOBILE 9542355545 --NA--

EMAIL dilipshashank3@gmail.com --NA--

8.EDUCATION PARTICULARS:

8(a).Qual/Stream/YOP: Final

year B.Tech / Aeronautical

Engin ee ring / 2014

Percentage 62.35%

Maximum Marks Marks Obtained Maximum Marks Marks O btained

1st Semester 1000 675 2nd Semester 750 525

3rd Semester 750 474 4th Semester 750 420

5th Semester 750 400

9.NAME AND ADDRESS OF COLLEGE WHERE STUDIED : Institute of aeronautical e nginee ring dundigal

rangareddy dist andhra pradesh

10.NAME OF UNIVERSITY TO WHICH COLLEGE AFFILIATED AND ADDRESS: JNTU HYDERABAD

11. COLLEGE STATE:Andhra Pradesh

12. DETAILS OF SSB INTERVIEW(S) AT TENDED:

Service Type O f Entry Name Of SSBMonth And

Year Of S SBBatch No. Rec/ Not Rec

Air Force AFCAT 2AFSB Mysore AUG 2013

13.Details of service under central/state Govt. if any (Candidates already in service should apply through proper channel and

obtain NOC from t he present employer.):NO

14.APPLICATION FORM TO BE SIGNED BY THE DIRECTOR O F ENGINEERING C O LLEGE/HEAD O F

DEPARTMENT

Certified that Miss/Mr.....................is studying in this Univeristy/

College/Institute and that details furnished by him in para 7 and 8 of the application form have been

checked with reference to relevant records and found correct.

Place : ...................... Date:

..................? Signature (Director/ HOD): .......... ...........................

DECLARATION 1.I, hereby declare that I am unmarried male/female, 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.

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 initiated against me for fraudulent entry and falsification of documents. I also accept that no TA/DA will be admissible to me

in such cases.

Note: The copy of the application form is to be submitted to the Campus Selection Team of Indian Navy at the time of Campus Interview.The

date and time of interview will be intimated.

Place : ...................... Date:

..................Signature of Applicant : ... ..... ...... ..... ...... ..... ...... . October 8 , 2013, 10:29 pm