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ON-LINE APPLICATION FOR TNPSC REGISTRATION

22041
Registration # : 11615431

Full Name :

H BALAMURUGAN

One Time ID : Name of The Post Applying for : Are you a Destitute Widow? : Are you a Differently Abled Person? : Are you an Ex-Serviceman ? : PPO No : Date of Discharge / Probable Discharge / Date : Are you a Government Employee? : Nationality / Citizenship : Application Fee / Intimation Charges details: Payment Mode: Amount : Personal Details : Date of Birth : Gender : Married : Religion : Candidate's Place of Birth : Native District : Father's Name : Father's Place of Birth : Mother Tongue : Mother's Name : Spouse's Name : Communal Category : Name of the Sub Caste : Certificate No : Date Of Issue : Issuing Authority : Taluk : District : Address for Correspondence :

-Group IV NA NO NO --NO Indian

Net Banking 125.00

09/05/1989 MALE No Hindu TIRUCHENDUR Tuticorin K HARIRAMAN Tuticorin Tamil H MUTHULAKSHMI -Backward Class(BC) Kammalar 2434/04 28/09/2004 Zonal Deputy Tahsildar Thiruchendur Tuticorin 159A,South New Street Tiruchendur

District State : Pin : Permanent Address :

Tuticorin Tamil Nadu 628215 159A,South New Street Tiruchendur

District State : Pin :

Tuticorin Tamil Nadu 628215

Pin : Contact Details : Email ID : Mobile No : EDUCATIONAL QUALIFICATION PARTICULARS : Exam Passed S.S.L.C : H.S.C : Degree : Post Graduate Degree : Others : Details regarding the prescribed qualification : Qualification Details : Other Equivalent Qualification Details : Certificate No : Year of Passing : Name of the Authority/ University : Preferential qualification for per notification : Year of Passing 2004 2006 2009 2012

628215

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chendur.balamurugan@gmail.com 9994997036

Medium of Instruction Tamil Tamil English English --

Whether studied Tamil as one of the subject Yes Yes Yes N/A

SSLC -1077972 2004 state board of school examinat Yes English Tamil ---

Type writing / Short hand Qualification

Type Writing Short hand

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Name of the Examination Centre District: Name of the Examination Centre : Compulsory Subject (apart from General Knowledge) : Do you claim Age Concession? : Do You Claim Fee Exemption? :

Thoothukkudi Tiruchendur General Knowledge with Tamil No No 1.Junior Assistant - Security (Post Code:2400) 2.Junior Assistant - Non Security (Post Code:2600) 3.Bill Collector (Post Code:2500) 4.Steno- Typist,GR-III (Post Code:2300) 5.Field Surveyor(Post Code:2800) 6.Draftsman(Post Code:2900) ,7.Typist (Post Code:2200) Not Applicable Not Applicable

Post Preference :

Criminal Case (Registered/Pending/Punishment awarded) : Participation in Political Activities (In agitation/As a Member of Political Organisation/Candidature in Election) : Post Qualification work experience (Start from present Employer) : Name of the Organisation Previous appearance for Oral Test / Written Test Name of the Post Designation

From(mm/yyyy)

To(mm/yyyy)

Nature of Duty

Register No.

Year

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DECLARATION:
1. I hereby declare that all the particulars furnished in this application are true, correct and complete to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the examination, action can be taken against me by the TNPSC. 2. I hereby declare that I will not be a party to any kind of canvassing on my behalf.

3. I further declare that I fulfil all the eligibility conditions prescribed for admission to the examination.

4. I have informed my employer in writing that I am applying for this Examination.

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5. I have gone through the Instructions etc. to candidates and the Commissions notification for this Recruitment before filling up the application form.

6. I declare that I possess the medical standards prescribed for the post(s) which I am now applying.

7. I certify that I have not been debarred by the TNPSC or any other recruiting agency.

8. I am not a dismissed Government Employee.

I accept the above declaration

Place:

Date: 2012-06-03 22:14:11

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference