1/3

ON-LINE APPLICATION FOR RECRUITMENT OF APPRENTICE DEVELOPMENT OFFICERS-2012-13

0033
Registration # : 1218157

Full Name :

Charles Darwin T

Category : Type of Applicant : Are you an Ex-Serviceman ? : Zone : Zone Code : Choice of Division : Division Code : Choice of Examination Centre : Centre Code : Applied For : Nationality : Personal Details : Date of Birth : Age completed as on 01.11.2012 : Gender : Husband's Name: Father's Name : Mother's Name : Correspondence Address : Address for Correspondence :

OBC Others NO Southern Zone 07 CHENNAI-I/II 701 CHENNAI 701 Urban Indian

02-06-1987 25 MALE

Thirunavukkarasu Parimala

No 580 4th Cross Street Ponni Amman Nagar T V Puram Ponneri

District State : Pin Code : Permanent Address :

Tiruvallur TAMILNADU 601204 No 580 4th Cross Street Ponni Amman Nagar T V Puram Ponneri

District State :

Tiruvallur TAMILNADU

2/3
Pin Code : Contact Details : Phone NO: Mobile No : Email ID : Qualification Details : Exam Passed Graduation / Equivalent (as on 01.11.2012): Master Degree / Post Graduate Diploma in Marketing Work Experience: Salary Roll(SR) No : Designation : Office : Date of Appointment : Date of Confirmation : Period Of Service after Confirmation in Months : Have you completed 3 years of service after confirmation in Class III post Agency Code No : Date of Appointment : Branch Office : Business Performance Details : Sr No Agency Year Net First Year's Premium No of Lives Subject / Stream BE ECE University/Board Year of Passing % of Marks Class / Grade 044-27971116 +919094772099 c.darwin123@gmail.com 601204

Anna University

01/04/2008

71.30

First Class

MBA

Anna University

01/05/2011

80.00

First Class

Have you completed not less than 5 years as an agent and has brought a net First Years Premium Income of not less than Rs. 5,00,000/- during the immediately preceding 5 agency years and a net First Year Premium Income of not less than Rs. 1,00,000/- on 50 lives in each of any 3 of these agency years? Have you completed not less than 4 years as an agent and has brought a net First Years Premium Income of not less than Rs. 1,00,000/- on 50 lives per year in any 3 of the immediately preceding 4 agency years? If Related to any Agent/Employee/Officer/Medical Examiner etc. LIC of India Please State : His / Her Name : Designation : Place of Posting / Working : Exact Relationship : Languages Known English Tamil Details of Pre-Exam Training Would you like to undergo Pre-examinationTraining:(Only for SC/ST) Declaration Read YES YES Write YES YES Speak YES YES

3/3
I hereby declare that all statement made in this application are true and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect or not satisfying the prescribed eligibility criteria for the post applied for ,my candidature is liable to be cancelled/rejected at any stage of selection.

Place:

Date: 17-12-2012

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