Paste Attested Passport Size Photograph (Do Not Staple) C Andidate Photo Declaration I , Son / D Aughter of Hereby Dec Lare and S Olemnly Affirm That All the Partic Ulars S Tated in the a Pplic Ation Form That Was S

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TO BE RETA INED A ND DISPLA YED A T A FCA T CENTRE A ND A IR FORCE SELECTION BOA RD

ADMIT AND IDENTITY CARD - AFCAT - February2013
AIR FORCE COMMON ADMISSION TEST
SUMA NTA KUMA R BISWA L 106787 Details of Candidate A FCA T No.: 106787 Father's Name: TIKESWA R BISWA L Mother's Name: BHUMISUTA BISWA L Date of Birth: 17 Jul 1991 Gender: Male Identification Mark 1: BLA CK MOLE ON RIGHT A RM Identification Mark 2: NA A A DHA R No.: E Mail: sahoomadhusmita92@gmail.com A ddress: A T/PO:LOKA PA DA ,VIA :BA GHIA BA GHA L,TOWN:SIMILIPA DA R,DIST:BOUDH, PIN:762030 Mobile: 9556699589 Details of A FCA T Centre A FCA T Centre: Kolkata (Barrakpore) A ir Force Station Barrackpore, PO- Bengal Enamel, Palta, Dist 24 Pargana North, Kolkata, West Bengal- 743122 Nearest Railway Station- Palta. Distance from Railway Station to Exam Centre 0.20Kms Kolkata Date of Examination: 24/2/2013 Time of Reporting: 8 A M Time of Examination: 10 A M Signature Thum b Im pre ssion

Paste Attested Passport Size Photograph (Do Not Staple)
C andidate Photo

DECLARATION
I ,_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ Son / D aughter of _ _ _ _ _ _ __ _ _ hereby dec lare and s olemnly affirm that all the partic ulars s tated in the A pplic ation form that was s ubmitted online for the A ir Forc e C ommon A dmis s ion T es t (A FC A T ) 1 / 2 0 1 3 , are true to the bes t of my knowledge and belief. I agree to abide by the rules and regulations given in the notific ation and als o to the dec is ion of the E xamination A uthority, on my admis s ion to the E xamination. I have noted that the E xamination A uthority has the right to withhold my res ult even after appearing in the E xamination in addition to any other ac tion as may be deemed fit in the event of any of the s tatements made above being found inc orrec t. I t is c ertified that I have gone through the ins truc tions c ontained in the notific ation.

Date :---------------Place :-----------------------

Le ft Thum b Im pre ssion for Me n R...
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