1/2

RECRUITMENT OF ASSISTANT ADMINISTRATIVE OFFICER

ON-LINE APPLICATION FOR Life Insurance Corporation of India - RECRUITMENT OF ASSISTANT ADMINISTRATIVE OFFICER

19028
Registration # : Full Name : Category : If Person with Disability : Type of Disability : Percentage of Disability : 1357102 DIWAKAR SC NO -

Do you intend to use the services of a scribe NA ( only for VH and OH candidates whose writing speed is affected by cerebral palsy)?: Are you an ECO/SSRCO ? : Are you a Confirmed Employee of LIC ?: SR No.: Designation: Place of Posting: Whether you belong to Religious Minority Community ? : Minority Religion : State/ UT which the Centre of Examination Belongs: Centre of Examination : Centre Code : Nationality : Application Fee / Postal Charges Details: payment in: Amount : Reference ID : Transaction Date : Personal Details : Date of Birth : Age completed as on 01.03.2013 : Gender : Marital Status : Husband's Name : Father's Name : Mother's Name : Address for Correspondence : SITHAMBARAM -18 DHAMU NAGAR P N PALAYAM SRKV POST District COIMBATORE 11-02-1986 27 MALE Unmarried ONLINE 50.00 MSPD2938337951 07-03-2013 NO Tamil nadu CHENNAI 263 INDIAN NO NO

2/2
State : Pin : Permanent Address : TAMILNADU 641020 18 DHAMU NAGAR P N PALAYAM SRKV POST District State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.03.2012): Exam Passed Subject/Stream Date of Passing 05-04-2006 aggregate marks obtained Graduation: BCA 1708.00 3000.00 56.93 Second Class maximum marks % of Marks Class / Grade sdiwakar06@gmail.com +919790417273 COIMBATORE TAMILNADU 641020

Post Qualification work experience details (Start from present Employer): Name of the Employer & Nature of Employment Designation and Rank if any From(mm/yyyy) To(mm/yyyy) Nature of duties performed Remark(Reason for Leaving) Years of Service (YY/MM)

Total Relevant Experience : Languages Known TAMIL ENGLISH Read YES YES Write YES YES Speak YES YES

DECLARATION:
I hereby confirm and declare that all the statements made and information provided by me in this Application are true, correct and complete to the best of my knowledge and belief. In the event of any information or the part of it being found false or incorrect before or after the recruitment process, action can be taken against me by the competent authority and my candidature/appointment will automatically be cancelled/terminated.

Place: Date: 07-03-2013 Signature of Applicant

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