ANNEXURE-B Application No.

_______________ (To be filled by office )

BIO-DATA 1 2 3 Advertisment : 05/2010 No. Post Applied for Name ( Mr./Miss/Mrs) In block Letteras in Matriculation/equivalent certificate

Father`s Name as in Matriculation/equivalent Certificate

Present Address for communication

PIN 6 Parmanent Address

PIN 7 8 9 Nationality Religion Whether SC/ST/OBC/PH/XS

10 State To Which Belongs 11 (a) Date Of Birth (D/M/Y) ( As per Matriculation/equivalent Certificate) (b) Age as on 15/12/ 2010 12 Languages Known 13 Academic / Technical/Professional Qualification ( Satrting From Matriculation or equivalent Examination) Examination Passed Board/University Division % Of Marks Year Of Passing Subject Taken

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Experience Name of the Employer

Designation of the post

Pay Scale

Nature of Duties

Period of employment Lastpay drawn From to with total emoluments

15

Detail of Traning/ Course attended if any SNO Name of the course/ Traning

Instituation

Contens

Duration

16

Any additional Information regarding Research publication

17 18 19 20 21

Telephone no. Land line Mobile No. E-Mail If Any Whether any relative working with any unit of SPMCIL Copy of documents attached 1 2 3 4 5

22 23 24 25 26

Date of Retirement PPO No./or Retirement order no. Organisation from where Retired Pan Card No. Whether any police Case /disc. Case is Pending against him in any court of Law

DECLARATION

I am here by affirmdeclare that the satements made in the eappliction are true to the best of my Knowledge and delief and I undertake that any doughtful mis representation material omission made in this appliction from will render the undersigend liable to Immediate Dismissal

Date :

Place :

( Signature of the Candidate )