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ON-LINE APPLICATION FOR PROBATIONARY OFFICER

33034

Registration #:

3684651

Full Name:

GRAHVARDHAN GAUTAM

Category : If Person with Disability : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe(only for VH and OH both hands affected by cerebral palsy) : Category Code : Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? Whether you belong to Religious Minority Community? : Religious Minority Community to which you belong : Are you an Ex-Serviceman : No of chances appeared in past : Bank You Prefer to Join: Preference 1 : Preference 2 : Preference 3 : Centre of Examination Centre code : Application Fee / Postal Charges Details : Deposit Journal No : SBI Branch Name : SBI Branch Code : Deposit Date : Amount :

SC NO --NO 01 [SC] NO NO -NO 0

State Bank of Bikaner & Jaipur State Bank of Hyderabad State Bank of Patiala Agra 66

6800545 Raja Mandi Agra 01892 11-06-2011 50

Personal Details :

Personal Details :
Date of Birth : Age as on on 01.06.2011. : Gender : Husband's Name / Father's Name : Mother's Name : Address for Correspondence : 13-09-1983 27 MALE SALIG RAM VAIJANTI MALA H. N. 46/97 Bheem Nagar Jagdishpura District State : Pin : Permanent Address : Agra UTTAR PRADESH 282002 H. N. 46/97 Bheem Nagar Jagdishpura District State : Pin : Agra UTTAR PRADESH 282002

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Contact Details:
Phone No : Mobile No: Email ID : Qualification Details (as on 01.06.2011): 12th Std : Diploma course after 10th : YES -9808318516 gvpanel@yahoo.com

Exams Passed
12th / Diploma : Graduation : Other Details :

Subject/Stream
Science Math Mechanical Engg

Year of Passing
2002 2010

% of Marks
51.20 66.82

Whether desirous of taking Pre-Exam Training (SC/ ST/Religious Minority Community) : If Yes Centre for Training :

NO --

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 according to the Central Recruitment & Promotion Department, my candidature is liable to cancelled. I am willing to serve anywhere in India including rural areas.

Place: Date: 24-06-2011 Signature of Applicant

GRAHVARDHAN GAUTAM

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