USER ID RINL20187242

POST
APPLYING FOR POST MANAGEMENT TRAINEE - CHEMICAL

PERSONAL AND CONTACT DETAILS

TITLE Mr. APPLICANT NAME CHETAN DEB

DATE OF BIRTH 26-JAN-1997 AGE AS ON 01/01/2020 22 YEARS 11 MONTHS 6 DAYS

NATIONALITY INDIAN GENDER MALE

FATHER'S NAME RAJAT KUMAR DAS CATEGORY EWS

CATEGORY 04-JAN-2020
CATEGORY O1 CERTIFICATE ISSUE
CERTIFICATE NO. DATE

ARE YOU PERSON

WITH AT LEAST 40% NO
DISABILITY?

DO YOU BELONG TO NO
MINORITY
CATEGORY?

DOMICILED IN J&K NO
STATE (BETWEEN
01/01/1980 TO
31/12/1989)

ADHAAR CARD NO. 866032267992

ALTERNATE MOBILE 7978000522

NUMBER

ADDRESS DETAILS
PERMANENT ADDRESS CORRESPONDENCE ADDRESS
ADDRESS LINE 1 QR NO B-36 ADDRESS LINE 1 QR NO B-36

ADDRESS LINE 2 MAHAVIRNAGAR ADDRESS LINE 2 MAHAVIRNAGAR

CITY BRAJARAJNAGAR CITY BRAJARAJNAGAR

DISTRICT JHARSUGUDA DISTRICT JHARSUGUDA

NEAREST RAILWAY BRAJARAJNAGAR NEAREST RAILWAY BRAJARAJNAGAR

STATION STATION

STATE ORISSA STATE ORISSA

PINCODE 768216 PINCODE 768216

EMAIL ID CHETANDEB26@GMAIL.COM MOBILE NUMBER 7377276840

PREFERRED TEST CITY

PREFERRED TEST CITY BHUBANESWAR
EDUCATION DETAILS
NAME OF MONTH AND
COURSE TYPE OF RESULT REGISTER / OVERALL
COURSE NAME COURSE NAME DISCIPLINE UNIVERSITY / NAME OF INSTITUTE YEAR OF
DURATION COURSE STATUS ROLL NO. PERCENTAGE
BOARD COMPLETION

10TH/SSC 10TH/SSC 10TH/SSC CBSE DAV PUBLIC SCHOOL PASS MAR 2013 6106007 96

BIJU PATTANAIK
QUALIFYING PARALA MAHARAJA
B.TECH CHEMICAL UNIVERSITY OF 4 YEARS REGULAR APPEARING MAY 2020 1601109052
DEGREE ENGINEERING
TECHNOLOGY
COLLEGE

WORK EXPERIENCE DETAILS

DO YOU HAVE RELEVANT WORK EXPERIENCE? NO

PAYMENT DETAILS
PAYMENT STATUS SUCCESS

PAYMENT MODE ONLINE

PAYMENT AMOUNT(Rs.) 590

TRANSACTION NUMBER 10005072020012600025

PAYMENT DATE & TIME 26-JAN-20 12:42:30 AM

DECLARATION
1. I DECLARE THAT I HAVE CAREFULLY READ AND FULLY UNDERSTOOD THE VARIOUS INSTRUCTIONS, ELIGIBILITY CRITERIA AND OTHER CONDITIONS AND I HEREBY
AGREE TO ABIDE BY THEM.
2. I DECLARE THAT ALL THE ENTRIES MADE BY ME IN THIS APPLICATION FORM ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
3 .I AM AWARE THAT IF ANY PARTICULAR INFORMATION FURNISHED BY ME IN THE APPLICATION ARE FOUND TO BE FALSE / INCORRECT / WRONG, AT ANY STAGE OF
RECRUITMENT OR LATER, I AM AWARE THAT I AM LIABLE TO BE DISQUALIFIED / CANCELLED / TERMINATED BY RASHTRIYAISPAT NIGAM LIMITED
WITHOUT ANY NOTICE.
4. I HAVE NOT CONCEALED ANY INFORMATION WITH RESPECT TO QUALIFICATION / WORK EXPERIENCE / DISCIPLINARY AND VIGILANCE ACTION (IF APPLICABLE).

SUBMITTED DATE: 25-JAN-2020

USER ID : RINL20187242
(SIGNATURE OF
APPLICANT)