SSC GD Form 2025 PDF

## STAFF SELECTION COMMISSION BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI - 110003 Constable (GD) in Central Armed Police Forces (CAPFs), SSF, Rifleman (GD) in Assam Rifles and Sepoy in Narcotics Control Bureau Examination - 2025 ### REGISTRATION NO: 10018255292 ### Application Completed (Co...

## STAFF SELECTION COMMISSION BLOCK NO. 12, CGO COMPLEX, LODHI ROAD, NEW DELHI - 110003 Constable (GD) in Central Armed Police Forces (CAPFs), SSF, Rifleman (GD) in Assam Rifles and Sepoy in Narcotics Control Bureau Examination - 2025 ### REGISTRATION NO: 10018255292 ### Application Completed (Contents Not Verified) | | **Candidate's Details** | | | | | | | | |---|---|---|---|---|---|---|---|---| | **1.** **Candidate's Name (As per the Matriculation Certificate)** | SHAILENDRA MARKAM | **2.** **New Changed Name** | | **3.** **Gender** | Male | **4.** **Category** | ST | **5.** **Date of Birth (DD/MM/YYYY)** | 13-08-2005 | | **6.** **Father's Name** | KANHAIYA MARKAM | **7.** **Mother's Name** | SARLA MARKAM | **8.** **Nationality** | Citizen of India | **9.** **Age as on 01/01/2025** | 19 Years and 8 Months 20 Days | **10.** **Visible Identification Mark** | Right Hand in Mall | | **11.** **Whether a Person with Benchmark Disability (PWBD)?** | No | **12.** **Matriculation (10th Class) Examination Board** | Madhya Pradesh Board of Secondary Education | **13.** **Matriculation (10th Class) Year of Passing** | 2021 | **14.** **Matriculation (10th Class) Roll No.** | 117430548 | | | ### Address Details | | **Correspondence Address** | | **Permanent Address** | | |---|---|---|---|---| | **15.1** | Ward No. 08, Gram Post Gaura Chapar, Tehsil Nainpur, Dist. Mandla | **16.1** | Ward No. 09, Gram Post Gaura Chapar, Tehsil Nainpur, Dist. Mandla | | | **15.2** | State: Madhya Pradesh | **16.2** | State: Madhya Pradesh | | | **15.3** | District: Mandla | **16.3** | District: Mandla | | | **15.4** | Pin: 481776 | **16.4** | Pin: 481776 | | | **17.** **Email** | [email protected] | **18** **IR Mobile Number** | 70028731768 | | | | **Educational Qualification** | | | | **Other Details** | | |---|---|---|---|---|---|---| | **19.** **Highest Educational Qualification** | Higher Secondary (10+2) | **20.1.** **EQ. Status** | Passed | **20.4.** **Name of Board** | Madhya Pradesh Board of Secondary Education | **20.6.** **Percentage** | 62.6 | | **20.2.** **Passing Year** | 2021 | **20.3.** **State/UT of Board** | Madhya Pradesh | **20.5.** **Roll Number** | 117430948 | **20.7.** **CGPA** | | | | **Armed Forces/Ex-Serviceman Details** | | | | **Other Details** | | |---|---|---|---|---|---|---| | **21.** **Whether you are an Ex-Serviceman (Ex-SM) /Serving in the Armed Forces?** | No | **21.2.** **Date of Discharge from Armed Forces (DD/MM/YYYY)** | | **21.4.** **Have you already joined a Civil Post by availing benefit of reservation for Ex-Serviceman (ESM)?** | No | | | | **21.1.** **Date of Joining the Armed Forces(DD/MM/YYYY)** | | **21.3.** **Length of Service in Armed Forces** | | **21.5.** **Date of Joining to Civil Post (DD/MM/YYYY)** | | **22.** **Whether Seeking Age Relaxation?** | No | | **22.1.** **If Yes, Age Relaxation Code** | | | | | | | | | | | | | | | | | **Personal Information** | | | | | | | **23.** **Do you want to make your personal information available for accessing job opportunities in terms of DoP&T’s OM No.39020/1/2016 ESTT(P) dated 21/06/2016?** | No | **24.** **Preference of Examination Center** | | | | | | **24.1.** **Examination Center (First Preference)** | MPR-Jabalpur (6007) | **24.2.** **Examination Center (Second Preference)** | MPR-Bhopal (6001) | **24.3.** **Examination Center (Third Preference)** | MPR-Indore (6006) | | | **25.** **Medium for Computer Based Examination (CBE)** | 01-Hindi | **26.** **Are you a National Cadet Corps (NCC) Certificate Holder** | No | **26.1.** **Type of the NCC Certificate** | | | | **27.** **Have you participated in any game/sport at the District/State/National/International Level?** | No | **27.1.** **Name of Sports/Game** | | **27.2.** **Level of Participation** | | | | **27.3.** **Year of Competition** | | **27.4.** **Medal/Position Achieved** | | | | | | ** 28.** **State/UT of Domicile** | Madhya Pradesh | **29.** **District of Domicile** | | **30.** **Have you migrated from the State/UT of your origin to State/UT of your domicile?** | No | | | ** 30.1** **Whether you would like to avail the benefit of reservation from the State/UT of your origin?** | | **30.2.** **State/UT of Origin** | | **30.3.** **District of origin** | | | | | | | | **31.** **Candidate belongs to Militancy/Naxal affected district?** | Yes | | | | | | | | **32.** **Candidate belongs to border district?** | No | | | | | | | | **33.** **Preference of Posts for CAPFs Organisations** | A C B D E F G H | | | | | | | | | | | | | | | | | | | ### Fee Payment | | | |---|---| | **Fee Payment** | EXEMPTED | | | | | | |---|---|---|---| | **Amount** | | **Transaction No** | | | | | **Transaction Date** | | ### Declaration I have read the Notice of Examination and accept all the terms & conditions mentioned therein. l hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief I understand that in the event of any information being found suppressed/false or incorrect or ineligibility being detected before or after the examination, my candidature/appointment is liable to be cancelled. I am willing to serve anywhere in India. I agree to authorize SSC to use my Aadhar data for verification purpose. Print taken on: 09/09/2024 14:07 PM **Number of attempts**: 1