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RECRUITMENT OF ASSISTANTS AS PER TO ADVERTISEMENT NO. 1 /ASST./2012-13

41031
Registration # : 1210892756

Full Name :

SURANJIKA DALAI

Category : If Person with Disability : Type of Disability : Percentage of disability :

SC NO -

Do you intend to use the services of a scribe (only for VH and OH candidates NA whose writing speed is affected by cerebral palsy)? : Are you an Ex-Serviceman? : Are you a Disabled Ex-Serviceman (DISXS)? : Are you a dependent of an Ex-Serviceman (DXS)? : Are you currently employee of Central Government/PSU/PSB in Group C or D? : Have you passed the matriculation or its equivalent examination of the Armed Forces and rendered at least 15 years of defense service? : Whether you belong to Minority Community ? : Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? : Are you seeking relaxation under widow/divorced women/women judicially Separated from their husbands and who are not re-married? : Are you staff of RBI? : If Yes, please specify the PF Index No : Nationality / Citizenship : Select the Office you are applying for : State / UT from which the candidate intends to appear : Centre of Examination : Centre Code : Are you proficient in the language of the state for which you are applying for recruitment ? : Personal Details : Date of Birth : Age completed as on 01.05.2013 : Gender : Husband's Name / Father's Name : Mother's Name : Address for correspondence : 13-07-1991 21 FEMALE PITABAS DALAI BAIJAYANTI MALA DALAI INDRA NAGAR Indian Bhubaneswar Odisha Bhubaneshwar 241 YES NO NO NO NA NA NO NO NO NO

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NANDAPUR ROAD SIMILIGUDA District : State : Pin code : Permanent Address : KORAPUT ORISSA 764030 INDRA NAGAR NANDAPUR ROAD SIMILIGUDA District State : Pin code : Contact Details : Phone No. : Mobile No. : Email ID : Qualification Details (as on 01.05.2013) : Exam Passed Subject /Stream Date of Passing % of Marks Name of University / Institute Graduation : MECHANICAL 01-05-2013 71.00 YES C LANGUAGE BASIC Languages Known English HINDI ODIA Application Fee Details : Payment In : Amount : NO FEE 0.00 Read YES YES YES Write YES YES YES Speak YES YES YES SIKSHA O ANUSHANDHAN First Class Class / Grade 9439402503 seemasuranjika@gmail.com KORAPUT ORISSA 764030

Working Knowledge of Computers : Details of Computer Knowledge :

DECLARATION:
I certify that the statements made by me in the application are true to the best of my knowledge and belief and understand that any willfully false statement is sufficient cause for rejection of my candidature at any stage of the selection process.

Place:

Date : 20-06-2013

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