HIMACHAL PRADESH PUBLIC SERVICE COMMISSION

H.P. Judicial Services - 2017

Application No : 872137

872137
1. Applicant's Name : SAMIRAH KHAN

2. Father's Name : MOHD. SAYEED KHAN

3. Date of Birth : 21/01/1994

4. Category: General - (01)

5. Sex : Female 6. State to which belongs: Other

7. Phone No. : 7503871317 8. Mobile No. :8505904111

9. Correspondance Address :
F-54, SECOND FLOOR, , JOHRI FARM, NOOR NAGAR EXTN., OKHLA, NEW
DELHI, DELHI, Pin:110025
10. Permanent Address :
938/11, TILIA KOT, OPP TO NOOR MASJID, LUCKNOW ROAD, , RAEBARELI,
UTTAR PRADESH, Pin:229001

11. H.P.Govt.Servant : No 12. Age Relaxation : No

13. Exam/Test Station Shimla
14. Academic Qualification :
S.No Qualifaction Board/ University Subjects % of Year
Marks
1 Matric ICSE PHY, CHEM. MATHS, 85.2 2009
BIO,HISTORY, GEOGRAPHY,
ENGLISH, HINDI, COMPUTER,
EVS
2 Plus 2/Equivalent ISC PHY, CHEM, MATHS, 71 2011
ENGLISH, COMPUTER, EVS
3 Bachelor’s Degree in JAMIA MILLIA ISLAMIA ALL LAW SUBJECTS 67.21 2016
LAW
4
5
15. Name, address (for Correspondence purposes) and telephone numbers of two respectable persons
unconnected with the candidate for verification of candidate’s credentials.
NOTE : Attach the credential certificates in original issued by these two persons.
1. Mr./Ms. MOHD. SUHAILAddress: - HOUSE NO. 196, TOP F, GALI NUMBER 14, GAFFAR MANZIL, JAMIA NAGAR, , PIN: 110025,
Phone: 8742991050
2. Mr./Ms. SHIKHAR AGARWAL, Address:- HOUSE NO 79/1A, JAGAN PRADHAN COMPLEX, JASOLA VIHAR, NEAR POCKET 10B,
NEW DELHI,Pin: 110025,Phone: 9654345372
16. Examination/Test Fee Details :
i. Registration ID 10001217879264 ii. Transaction ID : 14490488
iii. Branch Code : WL0001180 iv. Fee : 400
v. Date of Deposit : 01/01/2018
Details of Documents Attached :
1. 2. 3.
4. 5. 6.

DECLARATION
I hereby declare that I am an Indian National and the statements made in this application are true, complete and correct to the best of
my knowledge and belief. I undertake that in the event of any information being found false or incorrect at any stage, my
candidature is liable to be cancelled and if appointed, appointment itself shall be liable to be cancelled. I also solemnly declare that
I do not suffer from any of the disqualifications shown in the advertisement, Himachal Pradesh Judicial Service Rules, 2004 or
Himachal Pradesh Judicial Service (Syllabus and Allocation of Marks) Regulations 2005 and that I am eligible in all respects according
to eligibility criteria prescribed.
Appl. Date :01/01/2018 Signature of the Applicant