LIC HOUSING FINANCE LIMITED

2ND FLOOR, MUMBAI LIFE BUILDING,

45/47, VEER NARIMAN ROAD,
MUMBAI – 400 001

APPLICATION FOR THE POST OF ASSISTANT

(TO BE FILLED UP IN ENGLISH CAPITAL LETTERS ONLY)

Affix recent
passport size
self attested
CHOICE OF CENTRE FOR WRITTEN TEST : _____________ photograph
here
CENTRE CODE :

1. NAME IN FULL (IN ENGLISH , CAPITALS WITH SURNAME FIRST)

2. MAILING ADDRESS WITH PIN CODE

PINCODE

TELEPHONE NO. WITH STD CODE : _____________________MOBILE NO.___________________

EMAIL ID : ____________________________

3. PERMANENT ADDRESS WITH PINCODE

PINCODE

4. DATE OF BIRTH :

DD MM YY

AGE IN COMPLETED YEARS AS ON 01/02/2009 : _____ YRS ______ MONTHS

5. PARTICULARS OF DEMAND DRAFT ENCLOSED :

DEMAND DRAFT MICR NO. OF NAME OF THE ISSUING DATE OF DRAFT AMOUNT
NUMBER DEMAND DRAFT BANK/ BRANCH

6. NATIONALITY : ___________________
 7. SEX : MALE / FEMALE

8. MARITAL STATUS : MARRIED / UNMARRIED/ DIVORCEE (Strike out whichever is not applicable)

9. FATHER’S/ HUSBAND’S NAME : ____________________________

10. MOTHER TONGUE : _____________ OTHER LANGUAGES KNOWN

(i) SPEAK ___________________________
(ii) READ ____________________________
(iii) WRITE ____________________________

11. EDUCATIONAL QUALIFICATIONS (AS ON THE DATE OF APPLICATION)

EXAMINATION NAME OF THE MONTH & YEAR PERCENTAGE OF CLASS /

PASSED BOARD/ UNIV. OF PASSING MARKS DIVISION

12. COMPUTER QUALIFICATION (AS ON THE DATE OF APPLICATION)

NAME OF THE NAME OF THE YEAR OF DURATION OF

COURSE INSTITUTION/ PASSING THE COURSE
UNIVERSITY

13. PRESENT / PREVIOUS EMPLOYMENT DETAILS :

NAME OF THE TENURE OF POSITION HELD EMOLUMENTS
ORGANISATION EMPLOYMENT DRAWN
FROM-----TO--------

14. PLEASE FURNISH ADDRESS OF TWO REFERENCES :

(1) NAME : ____________________________________________

ADDRESS : _________________________________________
___________________________________________

(2) NAME : ____________________________________________

ADDRESS : _________________________________________
___________________________________________

15. ANY OTHER INFORMATION : _______________________________________________________________

DECLARATION:

I hereby solemnly declare and affirm that all the statements made in this Application are true to the best of
my knowledge and belief. I understand that in the event of any information being found false, incorrect or
incomplete or if I am found ineligible due to non-fulfillment of any of the eligibility conditions, my
candidature for the applied post is liable to be cancelled/ rejected at any stage of recruitment without
assigning any reasons and after appointment in that event, the company shall have complete rights to dismiss
me from the services of the Company.

Date : ____________
Place : ____________ Signature of the Applicant