ON-LINE APPLICATION FOR COMMON WRITTEN EXAMINATION(CWE) FOR RECRUITMENT OF Officer Scale-I, II and III

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20032
Registration # : 6000700232

Full Name :

RAJNISH JAKHUBHAI LONCHA

Post : Post Code : Category : If Person w ith Disability : Type of Disability : Percentage of Disability :

Officer Scale-I 01 SC NO -

Do you intend to use the services of a scribe (only for VI and OC both hands affected by cerebral palsy) ? : NA W hether Children/Family Members of those w ho died in 1984 Riots? : W hether domiciled in Kashmir Division of the State of J & K during the period 1-1-1980 to 31-12-1989? : Do you have any w ork experience ? : Are you an Ex-Serviceman ? : W hether you belong to Minority Community ? : Religion to w hich you belong : Have you passed "local language" as one of the subjects at Matriculation/Xth Standard: Nationality / Citizenship : State/ UT w hich the Centre of Examination Belongs : State / UT Code : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Amount : Reference ID : Transaction Date : Personal Details : Date of Birth : Age completed as on 01.06.2012 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 01-04-1989 23 MALE JAKHUBHAI HANSABEN 4-109 Ambedkar-Vas VITHON TA NAKHATRANA District State : Pin : Permanent Address : KUTCH GUJARAT 370675 4-109 Ambedkar-Vas VITHON TA NAKHATRANA District State : Pin : Contact Details : KUTCH GUJARAT 370675 ONLINE Rs. 50.00 MBBR2760311673 06-25-2012 NO NO NO NO NO YES INDIAN Gujarat 16 Bhuj 170

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Email ID : Phone No : Mobile No : Qualification Details (as on 01.06.2012): Exam Passed Graduation: Post Graduation/Equivalent : Others : Other Details : W hether desirous of taking Pre-Exam Training (SC/ST/ Minority Community) : If Yes, Centre for Training : Total Experience (in months) : Languages Known ENGLISH HINDI GUJARATI Read YES YES YES Write YES YES YES Subject /Stream BCA PGDCA CIC Date of Passing 12-03-2011 12-01-2012 10-12-2006

rajnishloncha@yahoo.co.in 9974685309

% of Marks 50.91 70.00 58.00

Class / Grade Pass Class First Class Second Class

NO --

Speak 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: 25-06-2012 Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to IBPS

Signature of Applicant

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