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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR CLERICAL CADRE

35026
Registration # : 2004549191

Full Name :

SNIGDHA DUTTA

Category : If Person with Disability : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe (only for VI & OC both hands affected by cerebral palsy) ? : Whether you Children / family members of those who died in 1984 riots? : Whether you domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? : Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex-Serviceman ? : Are you a disabled Ex-Serviceman (DISXS)? : Are you a dependent of an Ex-Serviceman killed in action ? : Have you passed in one of the following Armed Forces Examinations equivalent to Civil Examination of HSc/Pre-University? : IAF Education Test for Promotion to rank of Corporal : Passing Out (Indian Navy) Examination conducted by Boys Training Establishment, Visakhapatnam :

GENERAL NO NA NO NO NO NO NO NO

NO NO

Are you a matriculate Ex-Servicemen candidate, who has obtained the Indian Army Special Certificate of Education or corresponding Certificate in the Navy or the Air NO Force after having completed not less than 15 years of service in Armed Forces of the Union? : Are you seeking relaxation under widow / divorced women / women judicially Separated from their husbands and who are not re-married? : Whether Regular Employees of the Union Carbide Factory, Bhopal, retrenched from service (applicable to Madhya Pradesh state only)? : Nationality : State/ UT which the Centre of Examination Belongs : State / UT Code : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Name Of Payee Bank : Transaction No. : Branch Name : DP Code / Branch Code No : Deposit Date : CBS Bank of Baroda 200911500312256 ghughu danga 1945 20-09-2011 NO NO INDIAN West Bengal 45 Kolkata 218

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Amount : Personal Details : Date of Birth : Age completed as on 01.08.2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : State : Pin : Permanent Address : State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.08.2011): Exam Passed SSC/Equivalent : HSC/Equivalent : Graduation/Equivalent : Other Details : Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ ExServicemen /PWD) : If Yes, Centre for Training : Languages Known BENGALI ENGLISH HINDI --Read YES YES NO Write YES YES NO Speak YES YES YES Subject /Stream GENERAL ARTS BENGALI Date of Passing 05-05-2005 05-06-2007 15-07-2010 % of Marks 65.75 57.00 49.25 snigdhadutta4390@gmail.com 033-25483069 9836607902 04-03-1990 21 FEMALE SUBAL CHANDRA DUTTA -685 P.S Road Madhugar Dum Dum.KOL-3 WEST BENGAL 700030 685 P.S Road Madhugar Dum Dum.KOL-3 WEST BENGAL 700030 350

DECLARATION:
I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found untrue or incorrect at any stage or my not satisfying any of the eligibility criteria stipulated, my candidature is liable to be cancelled.

Place: Date: 23-09-2011 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