ONLINE APPLICATION FORM

DRDO ENTRY TEST - 2015

Advt. No. CEPTAM - 08

Cutoff/Closing Date - 8th Feb 2016

For Office Use Only :

Photograph

Signature

ONLINE APPLICATION NUMBER : 80113003798

Printed On Date :28 / 01 / 2016

Thumb Impression

1. POST NAME & CODE

STA'B' -[0113-MATHEMATICS]
2. Preference For Exam City
I. 16-KANPUR
II. 10-GORAKHPUR
III. 09-DELHI NCR
3. Candidate's Name as Recorded in X Class Certificate
ABDUL MALIK
4. Father's Name
ABDUL TAUWAB
5. Mother's Name
HASINA BEGUM
6. Date of Birth (as recorded in X Class Certificate)
23 / 05 / 1993 , Age as on Cutoff Date 22Y, 8M, 15D
7. a) Category
[Y]
[ ]

Unreserved (UR)
Scheduled Tribe (ST)

[ ]
[ ]

Scheduled Caste (SC)

Other Backward Class
(OBC)

[ ]
[ ]

Govt. Servant (GS)

Widow/Divorcee

7. b) Sub-Category
[ ]
[ ]

Ex-Service Man (ESM)

Meritorious Sports
Person (MSP)

[ ]

Persons with Disability (PWD)

[ ]

Orthopaedically
Handicapped (OH)
Visually Impaired (VI)

[ ]

[ ]

Hearing Impaired (HI)

8. Nationality : INDIAN
9. Willing to serve in Remote Area # : NA
10. Gender :Male [ Y ] Female [ ]
11. Contact Details (Note : All particulars given below in the
head should be maintained active till the end of recruitment
process)
a ) Address for Correspondence
Name : MR. ABDUL MALIK
C/O : ABDUL MALIK SON OF ABDUL TAUWAB
NH-24B, HOUSE NO. 2/13, BARA
GOSIYANA NEAR RAILWAY CROSSING
LUCKNOW ROAD RAEBARELI
City/State: RAEBARELI , UTTAR PRADESH
Pincode: 229001 , Landline No:
b ) Permanent Address
Name : MR. ABDUL MALIK
C/O
ABDUL MALIK SON OF ABDUL TAUWAB
NH-24B, HOUSE NO. 2/13, BARA
GOSIYANA NEAR RAILWAY CROSSING
LUCKNOW ROAD RAEBARELI
City/State: RAEBARELI , UTTAR PRADESH
Pincode: 229001 , Landline No:
c ) Mobile No
+91 - 8303426368
d ) Email
abdulmlk777@gmail.com

12. a) Educational Qualifications (Must mention all completed/result awaited/appearing)

Qualification

X
XII

ITI
B.Sc

Main Subjects / Trade

as mentioned on the
Certificate / Degree of
EQR
NA
PHYSICS
CHEMISTRY MATHS
ENGLISH HINDI
PHYSICS
CHEMISTRY MATHS

University / Board / Roll Year of

No.
Passing

Duration
of Course
(In years)

1113377
0727342

2007
2009

NA
2

0942251

2013

Maximum
Marks /
CGPA

Marks /
CGPA
Obtained

% of Marks
Secured

600
500

421
356

70.16
71.20

1350

610

45.18

Diploma
Graduation
PostGrad.
OTHERS1
OTHERS2
12. b) Higher Qualification [for post of STA 'B' / Tech 'A']
Have you Completed or pursuing M.E/M.TECH/PhD/M.Sc./B.Tech./B.E./AMIE/AMIETE etc.? YES [
Institute Name
Qualification
Status

] NO [ Y ]
Completion / Likely
Completion Date

13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)
Payment Method
API

Fee Amount
50.00

Payment Date
2016-01-28 17:33:04

Payment ID
47958670

Transaction ID Status
127273363
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 Duties
(dd/mm/yyyy (dd/mm/yyyy Performed
)
)

15. Important Endorsements

a) (i) Type of ID Proof :
AADHAR CARD
ID No.:
(ii) Height (cm) :
155 (5 Feet 1 Inch)
Weight (kg) :
Identification Mark :
CUT MARK ON LEFT FOREHEAD
(iii) Driving License : [for post of vehicle operator 'A' only]
(ii ) Two / Three Wheelers:
(i ) LMV :
(i ) HMV :

653588336224
55

(b) For the serving defence personnel only, claiming benefit of Ex-Serviceman
Name of Unit

Rank

Date of
Joining

Date of
Discharge

CO Name

Contact NO.

16. Other relevant information (If any)

17. Declaration
I ABDUL MALIK son/Daughter of ABDUL TAUWAB 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.
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 or
after the examination/recruitment my candidature/recruitment/appointment is liable to be cancelled.
18. Required at the time of document verification/trade test/interview, if shortlisted.
a) Left Hand Thumb Impression

b) Signature of Candidate

Place :
Date :

19. List Of Documents Uploaded

10th Class or Equivalent Certificate , EQR
Note : You are NOT REQUIRED to send print out of your application to the CEPTAM/DRDO at this time.
However, it is advised to keep this 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 post applied.
# for details, read CEPTAM-08 advertisement
ONLINE APPLICATION NUMBER : 80113003798

, Printed On Date :28 / 01 / 2016