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Office Use

Office Use

Office Use

Registration No
15034182938

1.Candidate Name

VINAY

2.Parent Name

PRATAPSINGH

TEJ BAHAUAR

3.Nationality

Indian

6.Qualification

Intermediate

SINGHCHUHAN

CHUHAN
4.Date Of Birth

21-12-1997

5.Marital Status

Un Married

EPCB
7.Intermediate/Voca 71

8.Name of

tional/Diploma

Intermediate/vocatio Higher School &

Higher School &

English %

nal/Diploma

Intermediate

Intermediate

Education

Education

10.Matric Roll No

1578738

11.Aggregate

13.EMail Id

pratapfact@gmail. 14.SOAFP

UP Board of

9.Matric Board

71

12.Mobile No

No

15.Discharged from No

com
16.Stream Applied

19.Exam Center

UP Board of

8795511305

Forces

Group-XY

3 ASC Kanpur

Choice 1

17.Identification

a cut mark on right 18.Candidate Height 176cm

mark

leg

20.Exam Center

2 ASC New Delhi

Choice 2

21.Exam Center

1 ASC Ambala

Choice 3

22.Permanent

EWS

23.Communication

EWS

24.Preference for

1st preference: X

Address

250/876,RATANP

Address

250/876,RATANP

group XY candidate 2nd preference: Y

UR

UR

only

COLONY,PANKI,

COLONY,PANKI,

Kanpur

Kanpur

Nagar,Uttar

Nagar,Uttar

Pradesh,208020,

Pradesh,208020,

DECLARATION BY THE CANDIDATE


I hereby declare that all statements made in this application are correct.I understand that I am
liable to be disqualified at any stage, if the information given is found to be
incorrect/incomplete/false. I undertake to produce all original certificates and statement of marks
and three photocopies of each, duly attested by a Gazetted Officer, at the time of appearing in the
Selection test. I am willing to undergo physical and medical test, at my own risk and will not be
entitled for compensation for injuries if any, sustained during such test. I am aware that the
decision by President, CASB will be final and binding on me.
Shirt Size: cm

Shoe Size(BATA):

Waist Size: Inch

Signature of the candidate

Signature of parent/guardian
(If candiddate below 18 yrs on the day of filling application)

Name(Gaurdian if applicable ) :
Place:

Paste your
photograph

Left Hand Thumb


impression
------------------------1

50341 82938

Date:

-----------------------Tear off and Paste on Envelope------------------- -----------------------Tear off and Paste on Envelope-------------------

To,
President
Central Airmen Selection Board
PO Box: 11807
New Delhi-110010

15034182938
Group-XY

50341 82938

71

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