Public Service Commission, West Bengal

APPLICATION FORM

(1) Name of the Post Applied For:
(2) Post Code:

(3) Name in Full:

(IN CAPITAL LETTERS)

(4) Father’s/Husband’s Name:

(5) Mailing Address: ______

Contact Telephone Number (if any):

(6) Permanent Address: ______

(7) Community / Category: Gen OBC SC ST PH

[Put ‘√’ mark in Appropriate Box]

(8) Whether SC/ST/OBC Certificate obtained Yes No

from competent authority of

Govt. of West Bengal:

[Copy of Certificate to be enclosed]

(9) If SC/ST/BC Candidate, mention Sub-Caste State Issuing Authority

(10) If Physically Handicapped, state the Category (Put ‘‘√’ mark in the appropriate box):
Blind/ Visually Challenged Hearing Impaired Orthopedically Handicapped % of Disability

(11) Sex: [Put ‘√’ mark in Appropriate Box] Male Female

(12) Date of Birth (As recorded in Madhyamik or equivalent Certificate): D D M M Y E A R

(13) Age as on 01.09.2008:

(14) Nationality:

(15) Marital Status: Married Single

(16) Qualification (Madhyamik and Onwards):

(17) Employment Exchange Registration No. with details (if any):

(18) Particulars of Bank Draft

(i) Name of the Bank & Branch:

(ii) Bank Draft No & Date :

(iii) Amount:

DECLARATION

I hereby declare that the particulars furnished herein are true to my knowledge. If any information is found to be false subsequently by the authority, my candidature for the post is liable to be rejected.

Date: Signature of the Candidate

…………………………………………………………………FOR OFFICE USE ONLY ……………………………………………………………

ADMIT CARD

(1)Name of the Post Applied for:

(2) Name of the Candidate (in block letters):

(3) Father’s / Husband’s Name:

(4) Mailing Address:

Signature of the Candidate

[Particulars of Sl. No. (1) to (4) above to be filled up by the Candidate]

(5) Date of Examination: (6) Time: (7) Venue:

[For Office Use Only]

Signature of the Issuing Authority