nausena bharti shashank
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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 [email protected] --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