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This online application is provisional subject to payment of application fees/ intimation charges

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Registration # : 1110616884

Full Name : S SHAIKSHAVALI

Category : GENERAL

If Person with Disability : NO

Type of Disability : -

Percentage of Disability : -

Do you in tend to use the services of a scribe (on ly for VI & OC

candidates whose writing speed is affected by cerebral palsy)? :NA

Whether Children/Family Members of those who died in 1984 Riots? : NO

Whether domiciled in Kashmir Division of the State of Jammu & Kashmirduring the period 1-1-1980 to 31-12-1989? :

NO

Do you belong to a Religious Minority Community? : YES

Religion to which you belong : Muslim

Are you an Ex-Serviceman? : NO

Are you a Disabled Ex-Serviceman (DISXS)? : NO

Are you a Dependent of an Ex-Serviceman (DXS)? : NO

Are you a matriculate Ex-Servicemen candidate, who has obtained the

Army Special Certificate of Education or corresponding certificate in the

Navy or Air Force after having completed not less than 15 years of service

in the Armed Forces of the Union? :

NA

Percentage of Marks :

Are you seeking relaxation under window / divorced women / women judicially

separated from their husbands and who are not re-married? : NO

Whether Regular Employees of the Union Carbide Factory, Bhopal,

retrenched from service (applicable to Madhya Pradesh state only)? :NO

Have you applied for the CWE for Clerical Cadre held in November/ December

2011?

Note: If Yes, Please enter your Registration Number

NO

Registration Number:

Nationality / Citizenship : Indian Muslim

State/ UT which the Centre of Examination Belongs : Karnataka

State / UT code : 26

Centre of Examination : Bengaluru

Centre code : 152

Application Fee / Intimation Charges :

Payment through : OFFLINE

Amount : 400.00

Personal Details :

Date of Birth : 10-06-1991

Age completed as on 01.10.2012 : 21

Gender : MALE

Husband's Name :

Father's Name : S USMAN

Mother's Name : S JAINABEE

Address for Correspondence : H.NO.49-1A-84 2ND FLOOR

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JNR NAGAR

KURNOOL

District KURNOOL

State : ANDHRA PRADESH

Pin code : 518002

Permanent Address : H.NO.49-1A-84 2ND FLOOR

JNR NAGAR

KURNOOL

District KURNOOLState : ANDHRA PRADESH

Pin code : 518002

Contact Details :

Phone No : -

Mobile No : 9505193708

Email ID : syedforall@gmail.com

Educational Qualification (as on 01.10.2012) :

Exam Passed Subject /Stream Date of Passing % of Marks Class / Grade

Graduation / Equivalent : ECE 18-05-2012 61.83 First Class

Knowledge of Computers : YES

Details of Computer Knowledge :Studied Computer/IT as a Subject in High

School/College/Institute

Do you have work experience? : NO

Total Experience in months (as on 01.10.2012) :

Other Details :

Would you like to undergo Pre-Exam Training (SC/ST/Minority Community/Ex-

Servicemen/PWD)? :NO

If Yes, Centre for Training : --

Languages Known Read Write Speak

English YES YES YES

Hindi YES YES YES

Telugu YES YES YES

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: 27-10-2012 Signature of Applican

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

NOTE: Please DO NOT SEND application printout to IBPS

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