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ON-LINE APPLICATION FOR COMMON WRITTEN EXAMINATION(CWE) FOR RECRUITMENT OF Officer Scale-I, II and III

14032
Registration # : 6000300023

Full Name :

Kaushal Kumar

Post : Post Code : Category : If Person with Disability : Type of Disability : Percentage of Disability :

Officer Scale-I 01 OBC NO -

Do you intend to use the services of a scribe (only for VI and OC both hands affected by cerebral palsy) ? : NA Whether Children/Family Members of those who died in 1984 Riots? : Whether domiciled in Kashmir Division of the State of J & K during the period 1-1-1980 to 31-12-1989? : Do you have any work experience ? : Are you an Ex-Serviceman ? : Whether you belong to Minority Community ? : Religion to which you belong : Have you passed "local language" as one of the subjects at Matriculation/Xth Standard: Nationality / Citizenship : State/ UT which the Centre of Examination Belongs : State / UT Code : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Amount : Reference ID : Transaction Date : Personal Details : Date of Birth : Age completed as on 01.06.2012 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 23-12-1986 25 MALE Sri Sunil Kumar Manorama Devi C/o R S Mishra 28a/8 Jia Sarai Near IIT Delhi Hauz Khas New Delhi District State : Pin : Permanent Address : South Delhi DELHI 110016 S/o Sri Sunil Kumar Baban Babu Cement Dukan Gola Bazaar Nagar Untari District Garhwa ONLINE Rs. 450.00 NO NO NO NO NO YES Indian Jharkhand 20 Daltonganj 189

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State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.06.2012): Exam Passed Graduation: Total Experience (in months) : Other Details : Whether desirous of taking Pre-Exam Training (SC/ST/ Minority Community) : If Yes, Centre for Training : Languages Known Hindi English Read YES YES Write YES YES --Speak YES YES Subject /Stream Commerce Date of Passing 05-07-2007 % of Marks 66.75 Class / Grade First Class kaushal23kush@gmail.com 9560835473 JHARKHAND 822121

DECLARATION:
I hereby declare that all statements made in this application are true. complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found untrue or incorrect at any stage or my not satisfying any of the eligibility criteria stipulated, my candidature is liable to be cancelled.

Place:

Date: 19-06-2012

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to IBPS