Dakshin Bharat Area Signal Company,

Fort Saint George, Chennai 600 009

1.Name of the Post :

2.Name of the Applicant (Capital Letters) :

3.Fathers Name / Husbands Name :

4.Date of Birth :

5.Sex :

6.Nationality :

7.Community Name / Religion :

8.Community Category (SC/ST/MBC/BC/OC):

9.Applied in which roster category : SC [ ]

ST [ ]
OBC [ ]
OC / UR [ ]

10.Educational Qualification :

Qualification Year of Pass Marks Other details (if any)

11.Other Qualification :
12.Address :

13.Experience if (any) :

14.Telephone No :

15.Email address :

16.Self Address Envelope with RS 25/- stamp affixed in each Envelope:

17.Details of enclosures :

I hereby declared that all the above statements made in this application are true, complete and
correct to the best of my knowledge and belief. I also declare that I have never been debarred
from government service. I have not been convicted by court of law for any affence. In the event
of any information being false or incorrect or ineligibility being detected before or after any test
my candidature will stand automatically.

Place :

Date : (Signature)