Bio-data

1. Name of the Applicant : GOPAL KRUSHNA MISHRA Affix a recent

2. Father/Guardian’s Name : Ramesh Chandra Mishra passport size
3. Date of Birth : 29TH June 1977 photograph
4. Permanent postal Address : At- Marudi Jagannath Pur
Po/Via- Burupada,
Dist- Ganjam
Pin- 761146, Orissa
Mob. No. +91-9438571962
5. Nationality : Indian
6. E-mail Address : gopalkrushnamishra.2009@rediffmail.com
7. Religion : Hindu
8. Category : General
9. Sex : Male
10. Marital Status : Married
11. Language Known : Oriya, English, Hindi
12. Educational Qualification :
Examination Passed Board/ University Year of passing Division Percentage
H.S.C , B.S.E.O 1993 2 nd
49%
+2 Science C.H.S.E 1996 3rd 37%
B.Sc Berhampur 2000 Pass 48%
University

DECLARATION

I do hereby declare that all above information furnished above are true to the best
of my knowledge & belief.

Place: Marudi Jagannath Pur

Date : 17/04/2009 (GOPAL
(KRUSHNA MISHRA)