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ONLINE APPLICATION FORMAdvt. No. CEPTAM - 07 DRDO ENTRY TEST -
2014 Closing Date - 17th Oct 2014
1. POST CODE
STA'B'-[0106-ELECTRICAL & ELECTRONICS]
2. Preference For Exam City
I. 17-KOCHI II. 03-BENGALURU III. 07-CHENNAI
3. Candidate's Name as Recorded in X Class Certificate
ANOOP K
4. Father's Name
DAMODARAN K5. Mother's Name
PREMAVALLY K
6. Date of Birth (as recorded in X Class Certificate)
14 / 06 / 1991
7. a) Category
[ ] Unreserved (UR) [ ] Scheduled Caste (SC)
[ ] Scheduled Tribe (ST) [ Y ] Other Backward Class(OBC)
7. b) Sub-Category
[ ] Ex-Service Man (ESM) [ ] Govt. Servant (GS)
[ ] Meritorious SportsPerson (MSP)
[ ] Widow/Divorcee
[ ] Persons with Disability (PWD)
[ ] OrthopaedicallyHandicapped (OH)
[ ] Hearing Impaired (HI)
[ ] Visually Impaired (VI)
For Office Use Only :
ONLINE APPLICATION NUMBER : 90106043071
Printed On Date :15 / 10 / 2014 22:51:4
8. Nationality : INDIAN
9. Willing to serve in Remote Area : NO
10. Gender :Male [ Y ] Female [ ]
11. Contact Details (Note : All particulars given below in
thehead should be maintained active till the end of
selectionprocess)
a ) Address for Correspondence
Name : MR. ANOOP K
C/O : DAMODARAN K
THORAPONAM HOUSE
KOLATHUR P.O.
City/State: KASARAGOD , KERALA
Pincode: 671541 , Landline No:04994211505
b ) Permanent Address
Name : MR. ANOOP K
C/O DAMODARAN K
THORAPONAM HOUSE
KOLATHUR P.O.
City/State: KASARAGOD , KERALA
Pincode: 671541 , Landline No:04994211505
c ) Mobile No
+91 - 9400411505
d ) Email
[email protected]
12. a) Educational Qualification (Mention all completed/result
awaited/appearing)
Qualification Main Subjects / Trade(Specify Subject / Trade
as mentioned on theCertificate / Degree ofEQR)
University / Board Year ofPassing
Durationof Course
(In years)
MaximumMarks
MarksObtained /
CGPA
% of MarksSecured
X NA GENERALEDUCATIONDEPARTMENT KERALA
2007 NA 1000 810 81
XII SCIENCE BOARD OF HIGHERSECONDARYEXAMINATION KERALA
2009 2 600 459 76.5
ITI
B.Sc
Diploma ELECTRICAL ANDELECTRONICSENGINEERING
DEPARTMENT OFTECHNICALEDUCATION KERALA
2012 3 2800 2173 77.6
Grad.PostGrad.
OTHERS1
OTHERS2
12. b) Higher Education
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13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per
Govt. rules)
Payment Method Fee Amount Payment Date Payment ID Transaction ID
Status
1164 50.00 2014-10-15 22:48:04 29509684 75042982 Processed
14. Employment Record in Govt./PSU/Autonomous Body etc. (If
any)
Name of Organization Post Held Pay Scale /Grade Pay
Period From Period to Nature of DutiesPerformed
15. Important Endorsements
a) (i) Type of ID Proof : AADHAR CARD ID No.: 591686319329
(ii) Height (cm) : 178 Weight (kg) : 50
Identification Mark : A BLACK MOLE ON THE LEFT RING FINGER
(iii) Driving License :
(ii ) Two / three Wheelers:
(i ) LMV :
(i ) HMV :
(b) For serving defence personnel only, claiming benefit of
Ex-Serviceman
Name of Unit Rank Date ofJoining
Date ofDischarge
CO Name Contact NO.
16. Other relevant information (If any)
17. Declaration
I ANOOP K son/Daughter of DAMODARAN K hereby declare that a) I
have read and understood all the provisions mentioned in the
advertisement and undertake to abide by them.
b) All the statements made in this application are true,
complete, and correct to the best of my knowledge and belief, and
have filled it inmy own handwriting.
c) I have submitted only one application for one Post in
response to this advertisement.
d) I understand that in the event of any information being found
suppressed, false or incorrect or any Ineligibility being detected
before orafter the examination/selection my
candidature/selection/appointment is liable to be cancelled.
18.
Place :
Date :
a) Left Hand Thumb Impression b) Signature of Candidate
Note : You are NOT REQUIRED to send print out of your
application to the DRDO's office at this time. How ever, we advise
to keep thisOnline application form and copy of the advertisement
for claiming travel concession from Railways, and also for future
references.CEPTAM does not undertake any scrutiny of application
before examination and the eligibility is verified only after
examination.Accordingly, mere allowing the candidates to appear in
the examination will not be construed as a ground of being eligible
for the postapplied.
ONLINE APPLICATION NUMBER : 90106043071 , Printed On Date :15 /
10 / 2014 22:51:4
