8/8/2019 Application for Grant of Permanent Commission in Naval

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APPLICATION FOR GRANT OF PERMANENT COMMISSION IN NAVALARMEMENT INSPECTION CADRE OF EXECUTIVE BRANCH

Regd No. ....................................... (For Official use only)

1. Applying for course: PC NAIC JULY-2011

2. Name in BLOCK capitals as in Matriculation certificate: - SIDDHARTH TIWARI 

3. Expanded full name if abbreviated in Sl. 2 above: - SIDDHARTH TIWARI 

4. Father's name as in your Matriculation certificate: - KESHAV KUMAR TIWARI

5. Father's Occupation/Designation: PRIVATE SERVICE

6. Permanent Address:-JR 207HINDALCO COLONY

HINDALCO INDUSTRIES LIMITEDRENUKOOT, SONEBHADRA (UP)

District: SONEBHADRA

State: UTTAR PRADESH 

PIN: 231217

Mobile: 9532988062 

7. Correspondence Address:-JR 207HINDALCO COLONY

HINDALCO INDUSTRIES LIMITEDRENUKOOT, SONEBHADRA (UP)

District: SONEBHADRA 

State: UTTAR PRADESH

PIN: 231217

Mobile: 9532988062 

Email: Siddharth.tiwari@live.com

8. Nationality: - INDIAN

9. Domicile: - NOT APPLICABLE 

10. Date of Birth: - (DD/MM/YYYY): 30/03/1988

11. Marital Status: - Unmarried

8/8/2019 Application for Grant of Permanent Commission in Naval

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12. Details of marks secured in Graduation and above:-

13. Specify stream during BE/BTech: ELECTRONICS

14. Name of College where studied and address:INSTITUTE OF TECHNOLOGY AND MANAGEMENTAL-1, SECTOR-7, GIDA, GORAKHPUR-273209

15. Name of University to which college affiliated and address:UTTAR PRADESH TECHNICAL UNIVERSITY(now Gautam Buddha Technical University)LUCKNOW, UTTAR PRADESH.

16. Have you attended any SSB interview earlier: (If yes, give details for all earlier attempts)

17. Details of service under central/state Govt., if any NOT APPLICABLE 

DECLARATION1. I, hereby declare that I am unmarried male/female, governed by nationality condition as laid down by the Government ofIndia 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 myknowledge and belief.3. I, fully understand that in the event of any information being found false or incorrect, appropriate action can be takenagainst me.

Place: RENUKOOT Signature

Date: 2nd November 2010 Name of the Applicant: Siddharth Tiwari 

Exam Passed

Semester/Year wise Marks secured

Semester/Year MaximumMarks

MarksObtained

% of Marks

BACHELOR OFTECHNOLOGY

INELECTRONICS

ANDCOMMUNICATIONS

ENGINEERING.

I 1 0 0 0 6 6 1 6 6

II1 0 0 0 7 6 6 7 7

III1 0 0 0 7 0 6 7 1

IV1 0 0 0 6 4 7 6 5

V1 0 0 0 6 1 8 6 2

VI1 0 0 0 6 2 2 6 2

VII1 0 0 0 6 9 9 7 0

VIII1 0 0 0 7 4 7 7 5

Total Marks & overall Percentage 8000 68.35 %

Service Type of entry Name of SSB Month & Year of SSB Batch No. Rec/NotRec.

Army STL-35 19 SSB, ALD July, 2010 DSTL-65987(ABS) NR

Air Force 78-AEC 4 AFSB, BSB September, 2010 NR

Air Force 77-AEC 1 AFSB, DDN March, 2010 NR