ROLL NO: _____________________

BIO-DATA (TO BE SUBMITTED IN FOUR SETS)

NAME : AGE (AS OF 01.07.2011) : YRS ADDRESS FOR COMMUNICATION MONTH
Space for DATE OF BIRTH (DD/MM/YYYY): Recent DAYS Passport size LANDLINE No. photograph (STD CODE) ____ No. _______________ MOBILE No.: _____________________ E-mail ID: ________________________ GENDER:

PINCODE: CASTE CATEGORY: SC ST OBC PHYSICALLY CHALLENGED CATEGORY: VI FATHERS NAME & OCCUPATION: OTHER FAMILY MEMBERS: NAME

GEN OC

EXSM: Yes HI

No

RELATIONSHIP

OCCUPATION DETAILS

PLACE OF DOMICILE (NATIVE): CITY

LANGUAGES KNOWN: MOTHER TONGUE TO READ

STATE
TO WRITE TO SPEAK

EDUCATIONAL QUALIFICATIONS 10th Standard onwards: NAME OF SCHOOL/ QUALIFICATION INSTITUTE/UNIVERSITY

MONTH & YEAR OF PASSING

PERCENTAGE OF MARKS/CLASS*

* Where only CGPA is provided by the Institute/University, the same should be converted into percentage and entered accordingly EXPERIENCE/ SERVICE DETAILS: LENGTH OF SERVICE NAME OF THE EMPLOYER & PERIOD OF EXPERIENCE NATURE OF DUTIES DESIGNATION PERFORMED FROM TO YEARS MONTHS

EXTRA-CURRICULAR ACTIVITIES ANY SPECIAL ACHIEVEMENTS

REFERENCE WITH ADDRESS & CONTACT NUMBERS (OF TWO PEOPLE NOT RELATED TO YOU)

: :

ANY OTHER IMPORTANT INFORMATION :

Date:

Signature of the Candidate