Application for CLERKSHIP EXAMINATION, 2019(Advertisement No.

5/2019)

REGISTRATION NO: PSCWB04316160182 PAYMENT ID: NOT APPLICABLE

Enrolment No: PSC04315244

Candidate Name: LITAN MANDAL
Father's Name: HAREN CHANDRA MANDAL
Mother's Name: SONEKA MANDAL
Place of Birth: Malda
Do you have ability to read, write and speak in YES
Bengali:
Whether your mother tongue is Nepali: NO
State your mother tongue: Bengali
State your choice of language in Part – II Bengali
(Group-B):
Date of Birth: 20. November .1995

Sex MALE Physically Challenged: NO

Whether Ex-Serviceman in any rank (whether NO Meritorious Sportsperson: NO
as a Combatant or as a Non-Combatant) in the
Were you debarred previously by the NO
Armed Forces of the Union?
Commission from appearing at any
Preferred language in Typing on computer: English examination/selection ?:
Nationality Indian Email Id: litanmandal593@gmail.com
Category SC
Sub-Caste NAMASUDRA
Issuing Authority Sub-Division officer MALDA(SADAR)
Issuing State West Bengal
Issue Date 2011-06-07

Address For Correspondence   Permanent Address  

Address : VILL:-AGRA DOBA PARA Address : VILL:-AGRA DOBA PARA
  P.O:-AGRA HARISH CHANDRA PUR   P.O:-AGRA HARISH CHANDRA PUR
  P.S:- HABIB PUR   P.S:- HABIB PUR
State: West Bengal State : West Bengal
District : Malda District : Malda
Pin: 732122 Pin: 732122
Mobile No. 9382844710 Mobile No. 9382844710

Academic Qualifications (Madhyamik or equivalent and onwards)

Examination Examination Year of Name of Subjects Taken Division/Class/Grade Marks Remarks
Name Passing Board/Council/University %
Class 10th West Bengal Board Of 1st Language (1st paper),1st Language (2nd paper),2nd
or MADHYAMIK 2011 Secondary Education Language,Math.,P.sc.,L.sc,Hist,Geo A+ 83.62% P
equivalent
Class 12th HIGHER West Bengal Council Of
or SECONDARY 2013 Higher Secondary BNGA,ENGB,CHEM,MATH,PHYS,BIOS,ENVE A 72.6% PASSED
equivalent EXAMINATION Education
Graduation B.Sc. UNIVERSITY OF GOUR First Class with RESULT-
(Bachelor (Honours) 2016 BANGA MTMH(Hons),PHSG(General),CMSG(General),BNGM(Compulsory),ENVS(Compulsory) Honours 62.50% 1
Degree)

Have you at any time been NO

employed ?
Any other information : Basic Computer

Center Preference  
Preferred examination center for Part-I Malda

Option for posting in order of preference for the vacancies  

Preference I Secretariat Departments
Preference II Directorates
Preference III Regional Offices including District Offices of one particular district or Kolkata

I solemnly declare that :

a) I am eligible to apply for the examination as per the notification.
b) All statements made in this application are true, complete and correct.
c) Original documents will be produced on demand.
d) I agree to take this examination on the condition that the Commission may cancel my candidature if at any stage I am
found ineligible.
I have obtained all my certificates (Qualification, Disability Certificate and/or Caste) within the date of submission of my
application.
I have informed the Head of my Office or Department in writing that I am appling for this examination (Please click the box if you are in service of Govt. or Local or Statutory Body).

I agree that all the information provided here, are correct according to my knowledge
PLEASE REVIEW THE ABOVE DETAILS CAREFULLY FOR ANY ERRORS BEFORE CONFIRMING SUBMISSION.

YOU WILL NOT BE ABLE TO MAKE ANY CHANGE AFTER CONFIRMATION OF SUBMISSION
THE FORM WOULD BE CONSIDERED SUCCESSFULLY SUBMITTED ONLY AFTER PAYMENT OF EXAMINATION FEE ( IF APPLICABLE)
PLEASE DOWNLOAD YOUR ADMIT CARD BEFORE EXAMINATION

Date : 20-03-2019

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