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Application Form (Preview)

Your Personal Details:

Salutation: MR. Gender: MALE Applicant's Name SHASHI KANT KUMAR Date of Birth 10/8/1989 Father's Name RAJENDRA PRASAD Mother's Name GYANTI DEVI Marital Status: SINGLE You have ordinarily been domiciled in Kashmir Division of J & K State NO during the period from 01.1.1980 to 31.12.1989 Are you Resident of Assam State during the period from NO 01.01.1980 to 15.08.1985? Are you an Existing Confirmed Employees of Public Sector General Insurance Companies (including GIC & Agriculture Insurance Company of India Ltd.)? Are you an Ex-Serviceman NO Category SC Person With Disabilities (PWD) NO Citizenship INDIAN Choice of State for PUNJAB Examination Choice of Examination Centre LUDHIANA
Qualification Details: Qualifying Discipline Qualifying Degree Your Communication Details: Permanent Address: Address Line 1 Village/City State S/O- RAJENDRA PRASAD, VILL+P.OBELSAND, BELSAND BIHAR Address Line 2 Pin Code INFORMATION TECHNOLOGY B. TECH / B.E IN INFORMATION TECHNOLOGY

Your Photo Your Signature

NO

P.S- BARAULI, DISTRICT- GOPALGANJ 841413

Postal Address: Address Line 1 S/O- RAJENDRA PRASAD, VILL+P.O- Address BELSAND, Line 2 P.S- BARAULI, DISTRICT-

Village/City State Mobile No Email Id

BELSAND BIHAR 919803444417 SHASHI.860@REDIFFMAIL.COM


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GOPALGANJ Pin Code 841413 Landline No

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