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    Personal Details: Thanks For Submitting Your Application Form1331536which Can Be Used For All Future Correspondence

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    Premchandra Gupta
    This document is an application form submitted by Sheshmani Gupta for the CPCT exam. It includes his personal details like name, date of birth, address, education qualifications from 10th standard to graduation, preferred exam date and cities. It also shows that he has paid 660 rupees as application fee online on September 15th, 2019 and attached his 10th and 12th mark sheets. At the end, he declares that the information provided is true.

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    Personal Details: Thanks For Submitting Your Application Form1331536which Can Be Used For All Future Correspondence

    Uploaded by

    Premchandra Gupta
    26 views2 pages
    This document is an application form submitted by Sheshmani Gupta for the CPCT exam. It includes his personal details like name, date of birth, address, education qualifications from 10th standard to graduation, preferred exam date and cities. It also shows that he has paid 660 rupees as application fee online on September 15th, 2019 and attached his 10th and 12th mark sheets. At the end, he declares that the information provided is true.

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    This document is an application form submitted by Sheshmani Gupta for the CPCT exam. It includes his personal details like name, date of birth, address, education qualifications from 10th standard to graduation, preferred exam date and cities. It also shows that he has paid 660 rupees as application fee online on September 15th, 2019 and attached his 10th and 12th mark sheets. At the end, he declares that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views2 pages

    Personal Details: Thanks For Submitting Your Application Form1331536which Can Be Used For All Future Correspondence

    Uploaded by

    Premchandra Gupta
    This document is an application form submitted by Sheshmani Gupta for the CPCT exam. It includes his personal details like name, date of birth, address, education qualifications from 10th standard to graduation, preferred exam date and cities. It also shows that he has paid 660 rupees as application fee online on September 15th, 2019 and attached his 10th and 12th mark sheets. At the end, he declares that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    9/15/2019 CPCT

    Thanks for submitting your Application


    Form1331536which can be used for all
    future correspondence
    Amount: 660.00
    Payment Transaction No: QUR27982962565

    Note : Application form has been submitted successfully.

    Application Form

    Personal Details

    Application Number: 1331536

    Nationality: Indian

    Name of The Candidate: SHESHMANI GUPTA

    Father's Name: ANGAD PRASAD GUPTA

    Mother's Name: CHANDRA BATI GIPTA

    Gender: Male

    Category: UR

    Date of Birth: 18/Dec/1992

    Email ID: [email protected]

    Mobile No: 7509579702

    Aadhar No: 518689605409

    Are you Physically handicapped?(With More than


    No
    40% Disability?

    Keyboard layout for Hindi typing: Ramington

    Address

    Address: E-49 MIG COLONY RSS NAGAR

    State/UT: MADHYA PRADESH

    Tehsil/City: INDORE

    District: INDORE

    Pincode: 452001

    Qualifying and Work Details

    What is your highest qualification? Graduation

    https://www.digialm.com/EForms/BillDeskWithHMACAfterPaymentAction.do?formOrgType=5100ZZ1172ZZonlinepayguv# 1/2
    9/15/2019 CPCT

    Board/Institution/University Year of Total Marks Roll


    Title Subject Class/Grade/Percentage
    Name Passing Marks Obtained Number

    GOVT BOYS H S SCHOOL


    10th GENERAL 2007 500 415 83.00 173527561
    MAJHAULI

    12th PCM SARASWATI H S SCHOOL SIDHI 2009 500 421 84.20 293515898

    BE
    Graduation SATI VIDISHA 2014 10 7.5 75.00 0108EE101057
    ELECTRICAL

    Preferred Cities

    Prefered City1: Indore

    Prefered City2: Ujjain

    Prefered City3: Bhopal

    Preferred Exam Date

    Exam Date: 06/Oct/2019

    Payment Mode: online

    Amount: 660.00

    Payment Status: S

    Payment Receipt no: 20190915

    Payment Transaction No: QUR27982962565

    Attachment

    To view XII certificate Click here.

    To view X certificate Click here.

    Declaration

    I do hereby declare that the above information filled in the application form is true and correct to the best of my knowledge. I do affirm and declare that I have
    applied for exam as per the CPCT rules and regulations as mentioned in the rulebook. If my above information is found wrong my candidature may be debarred
    and my CPCT score card will be invalid.

    Candidate Signature
    Version 13.07.01

    https://www.digialm.com/EForms/BillDeskWithHMACAfterPaymentAction.do?formOrgType=5100ZZ1172ZZonlinepayguv# 2/2

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