Recruitment of Administrative Officer (Scale-I)

19029Please paste your recentpassport size photographand sign across it. Pleaseretain atleast 5 copies ofsame photograph with youfor subsequent use.

Registration # : 1011727

Full Name : Raib Das

Group: Group J Generalist

Code No. : 10

Category : SC

If physically challenged : NO

Type of Disability : -

Percentage of Disability : -

Do you wish to use the services of a scribe(in case a Written Examination is held, only for VH candidates whose writing speed is affected by cerebral palsy)?:

NA

Are you an Emergency Commissioned Officers (ECO) & Short Service & Retrenched Commissioned Officers(SSCRO)? :

NO

Period of Service (in months) : --

Whether you persons who have ordinarily been domiciled in Kashmir Division of J&K State during the period01.01.1980 to 31.12.1989 ? :

NO

Are you Resident of Assam State during the period from 01.01.1980 to 15.08.1985 ? : YES

Are you a confirmed employees of General Insurance Corporation of India, Public Sector General InsuranceCompanies, Tariff Advisory Committee & AICIL?:

NO

Nationality : Indian

Centre of Examination : Guwahati

Centre code : 18

Application Fee / Postal Charges Details :

Payment In: Axis Bank

Transaction ID/Journal No : M175995

Branch Name : Fancy bazar

Branch Code Number : 608

Date of Remittance : (24.04.2012 - 31.05.2012)18-05-2012

Amount : 100

Personal Details :

Date of Birth : 18-01-1990

Age completed as on 01.04.2012: 22

Gender : MALE

Marital Status : Single

Husband�s Name / Father�s Name : Sunil chandra das

Mother's name : Kalpana das

Address for Correspondence : C/o-sunil Ch Das

Add-goshaion ColonyN-area W/no-2

Lanka Nagaon Assam

District : Nagaon

State : ASSAM

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Total Relevent Experience (in months) : -

Pin code : 782446

Permanent Address : C/o-sunil Ch Das

Add-goshaion ColonyN-area W/no-2

Lanka Nagaon Assam

District : Nagaon

State : ASSAM

Pin code : 782446

Contact Details :

Phone No. : 03674-256403

Mobile No. : 9401878921

Email ID : rajibdas777@gmail.com

Educational and Professional Qualification Details(as on 01.04.2012):

Exam Passed Name of theSubject/Stream

Name of Institute/College/ University

Month andYear ofPassing

% of Marks Class/Grade

Graduation : Science LCB 08/2011 70.75 First Class

Have you passed at least 3 papers of the examination conducted by Actuarial Society of India?: NO

Working Knowledge of Computers : YES

Details of Computer Knowledge :MS office Ms word tallypc repairin

Post Qualification work experience details (Start from present Employer) :

Name of the Employer &Nature of Employment

Designation and Rank From(mm/yyyy) To(mm/yyyy) Nature of duties performed Reason for Leaving Year of Service (YY/MM)

Languages Known Read Write Speak

English YES YES YES

Bengali YES YES YES

Assamese YES YES YES

DECLARATION:

I hereby confirm and declare that all the statements made and information provided by me in this Application are true, correct and complete to the best of my knowledge and belief. In the event

of any information or the part of it being found false or incorrect before or after the recruitment process, action can be taken against me by the competent authority and my candidature/appointment willautomatically be cancelled/ terminated.

Place:

Date: 23-05-2012 Signature of Applicant

Raib Das

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application print-out to the Bank

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