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                                                  ON-LINE APPLICATION FOR TNPSC REGISTRATION

Registration # :                                                       11404109

Full Name :                                                            A ABDULRAJAK

One Time ID :                                                          581636
Name of The Post Applying for :                                        Group IV
Are you a Destitute Widow? :                                           NA
Are you a Differently Abled Person? :                                  NO
Are you an Ex-Serviceman ? :                                           NO
PPO No :                                                               --
Date of Discharge / Probable Discharge / Date :                        --
Are you a Government Employee? :                                       NO
Nationality / Citizenship :                                            Indian

Application Fee / Intimation Charges details:
Payment Mode:                                                          NO FEE
Amount :                                                               0.00

Personal Details :
Date of Birth :                                                        02/06/1982
Gender :                                                               MALE
Married :                                                              No
Religion :                                                             Muslim
Candidate's Place of Birth :                                           KUMBAKONAM.
Native District :                                                      Thanjavur
Father's Name :                                                        A ABDULHAMEED
Father's Place of Birth :                                              Thanjavur
Mother Tongue :                                                        Tamil
Mother's Name :                                                        A ARIFABEGAM
Spouse's Name :                                                        --

Communal Category :                                                    Backward Class(BC)

Name of the Sub‐Caste :                                                mulism labbai
Certificate No :                                                       2566683

Date Of Issue :                                                        25/06/1999
Issuing Authority :                                                    Zonal Deputy Tahsildar

Taluk :                                                                Kumbakonam
District :                                                             Thanjavur

Address for Correspondence :                                           12-3/NA III RD STREET,
                                                                       K.M.S. NAGAR, MELACAUVERY,


District                                                               Thanjavur
State :                                                                Tamil Nadu

Pin :                                                                  612002
Permanent Address :                                                    12-3/NA III RD STREET,

                                                                       K.M.S. NAGAR, MELACAUVERY,

District                                                               Thanjavur
District                                                                                                         Thanjavur                                                                               2/3
State :                                                                                                          Tamil Nadu

Pin :                                                                                                            612002

Contact Details :
Email ID :                                                                                             
Mobile No :                                                                                                      9445304007


             Exam Passed                           Year of Passing                Medium of Instruction                Whether studied Tamil as
                                                                                                                         one of the subject
                S.S.L.C :                                 1999                              Tamil                                   Yes

                 H.S.C :                                  2001                              Tamil                                   Yes

                Degree :                                  2004                             English                                  Yes

Others :                                                                                                         --

Details regarding the prescribed qualification :
Qualification Details :                                                                                          Other Equivalent Qualification

Other Equivalent Qualification Details :                                                                         B.A.
Certificate No :                                                                                                 01116

Year of Passing :                                                                                                2004
Name of the Authority/ University :                                                                              BHARATHIDASAN UNIVERSITY

Preferential qualification for per notification :                                                                Yes

                                                                                                                                           English      Tamil

Type writing / Short hand Qualification                                                                              Type Writing            SG          SG

                                                                                                                     Short hand               --         --

Name of the Examination Centre District:                                                                         Thanjavur

Name of the Examination Centre :                                                                                 Kumbakonam
Compulsory Subject (apart from General Knowledge) :                                                              General Knowledge with Tamil
Do you claim Age Concession? :                                                                                   No
Do You Claim Fee Exemption? :                                                                                    Yes

Under What Category? :                                                                                           Backward Class/Backward Class (Muslims)
No of free Attempts :                                                                                            0
                                                                                                                 1.Junior Assistant - Non Security (Post Code:2600)
                                                                                                                 2.Junior Assistant - Security (Post Code:2400)
                                                                                                                 3.Bill Collector (Post Code:2500)
Post Preference :
                                                                                                                 4.Typist (Post Code:2200)
                                                                                                                 5.Field Surveyor(Post Code:2800)
                                                                                                                 6.Draftsman(Post Code:2900)
Criminal Case (Registered/Pending/Punishment awarded) :                                                          Not Applicable

Participation in Political Activities (In agitation/As a Member of Political
                                                                                                                 Not Applicable
Organisation/Candidature in Election) :
Post Qualification work experience (Start from present Employer) :

                 Name of the Organisation                                   Designation                               From(mm/yyyy)                       To(mm/yyyy)             Nature of Duty

Previous appearance for Oral Test / Written Test

                                        Name of the Post                                                                                  Register No.                                   Year

                                                   --                                                                                              --                                      --

                                                   --                                                                                              --                                      --


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

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

5. I have gone through the Instructions etc. to candidates and the Commission’s 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


Date: 2012-05-29 14:26:44                                                                                                                                   Signature of Applicant

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

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