APPLICATION FORM

DRDO ENTRY TEST – 2011 SECTION ‘C’

Closing Date: 18th Feb, 2011
For Office Use Only:

Affix Recent
Passport size Signature of the Candidate
coloured Left hand
Photograph, Thumb
Self attested Impression 7. NATIONALITY

8. GENDER Male Female

1. Post Code (See SEC ‘A’) 2. Preference for Exam City (Write Code) 9. A) Address for Correspondence
(This address shall be used till the end of selection process)(Capital Letters)
I. II. III.
NAME: ______________________________
3. Candidate’s Name as recorded in X Class Certificate: C/o: ________________________________
(Leave one blank space between parts of the name)
ADDRESS: ____________________________
___________________________________
4. Father’s / Mother’s / Husband’s Name ___________________________________
(Leave one blank space between parts of the name)

STATE: PIN:

5. A) Date of Birth (as recorded in X Class Certificate) B) Present Address (Capital Letters)
D D M M Y Y Y Y Age as on YY MM NAME: ______________________________
Closing Date
C/o: ________________________________
B) (i) Are you seeking age relaxation? YES NO
ADDRESS: ____________________________
(ii) If yes, Attach proof on standard format
___________________________________
6. Category (Please tick () in the appropriate Box(es))
___________________________________
Category Sub-category
PWD : STATE: PIN:
Unreserved (UR) Ex-Service Man
(ESM) Orthopaedically
C) Telephone Nos.
Scheduled Handicapped (OH)
Caste (SC) Govt. Servant (GS) Landline
Meritorious Sports Hearing Impaired
Scheduled (HI)
Person (MSP) Mobile
Tribe (ST)
Widow/Divorcee Visually Impaired
Other Backward (VI)
Class (OBC) D) E-mail
Other (specify)..…….........................................
_________________________@_____________________

10. Educational Qualifications (Attach Self Attested Copy as Proof)

Examination Passed/ Year of Duration % of Marks
Main Subjects/ Trade University/ Board Division
Appearing Passing of Course Secured

X
XII
B.Sc./Diploma/ITI
Master’s Degree
Others/ Pursuing

11. Fee Details

A. Fees Paid Fees Exempted (Attach appropriate proof, if exemption claimed)

B. Details of IPO
Name of Post Office Serial No(s). of IPO Date of Issue Amount (`)
12. Mention details if registered in Employment Exchange (Optional)
Name & Address of Employment Exchange Registration No. Date of Registration

13. Employment Record in Govt./PSU/Autonomous Body etc.

Period Nature of Duties
Name of Organization Post Held Pay Scale/Grade Pay
From To performed

14. ENDORSEMENT FOR THE SERVING DEFENCE PERSONNEL CLAIMING BENEFITS OF EX-SERVICEMAN

Ref/Letter No. ………………………………….. Date ……………………………………..

 The application of (Rank) ………………………………… (Name) ……………………………………………………………………………

(Date of Birth) …………………………… (Date of Joining) ………………………. (Date of Discharge*) ………………………… is
hereby forwarded with the affirmation that we have no objection to his/her application being considered.

th
* Only personnel whose date of discharge is within one year from the closing date (Thus, last date is 17 Feb, 2012) will be
considered.

Signature
Competent Authority
(with office seal)
15. Any other relevant information …………...………………………………………………………………………………………………….………

16. Declaration:
I ………………………………………………..….…… Son/Daughter/Wife of ………………………………………………………….
hereby declare that :
A) All the statements made in this application are true, complete, and correct to the best of my knowledge and belief, and
have been filled in my own handwriting.
B) I have submitted only one application for one Post in response to this advertisement.
C) I have read and understood all the provisions mentioned in the advertisement and undertake to abide by them.
D) I understand that in the event of any information being found suppressed, false or incorrect or any ineligibility being
detected before or after the examination/selection, my candidature/selection/appointment is liable to be cancelled.

17. (A) Left hand Thumb Impression (B) Signature of Candidate

PLACE : ……………………………………………. DATE : …………………………………………….

18. Please tick mark () the following CHECK LIST-

(i) Application Form signed on both pages and photograph pasted
(ii) Self Attested Copies of all required Certificates/Documents attached
(iii) Proof of Age (i.e. self attested copy of X-Class Certificate) attached
(iv) IPO for examination fee attached
(v) Self Attested Copies of SC/ST/OBC/PWD etc certificate attached, if claimed

Note: Candidates are advised to retain the photocopy of their application form and copy of the Advertisement for claiming concession from Railways.