Application details of Registration-Id: 51100313182 for Junior Engineers (C, E, M etc) Examination - 2013

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PART - I Examination Centre Name Gender Date of Birth Father's Name Mother's Name Nationality Physically Handicapped Community Fee Exemption Claimed Whether Ex-Serviceman MPR - Raipur(6204) ABHISHEK TIWARI Male 22-02-1987 NAGENDRA NATH TIWARI NIRMALA TIWARI Indian No General No No

Whether belong to Minority No Community Age Relaxation Claimed Email ID No abhi007.tiwari@gmail.com H.No. B-13 Teachers Colony Vidya Nagar Pendra Postal Address Bilaspur Chhattisgarh - 495119 Mobile: 9074177929 Mechanical English

Subject for Paper II : Medium of Paper II :

Pref. for Post Order of Preference 1. JE(Mechanical) Central Water Commission

Code I K

Order of Preference 2. JE(Electrical/Mechanical), Military Engineering Service 4. 6.

Code F

3. JE(Mechanical) Farakka Barrage 5.

7. 9. 11. Pref. of States/U.T. Order of Preference 1. Chhattisgarh 3. 5. 7. 9. 11. 13. 15. 17. 19. 21. 23. 25. 27. Educational Qualification BE Name of the Organisation(s) SSIET

8. 10.

Code E

Order of Preference 2. Madhya Pradesh 4. 6. 8. 10. 12. 14. 16. 18. 20. 22. 24. 26. 28.

Code O

Subject Mechanical Engineering Designation Assitant Professor Nature of Duty(ies) Teaching

% of Marks 77.54 From 18-082009

Medium English To 25-022013

PART - II [Fee Payment Details, Photograph & Signature of Registration-Id: 51100313182] Fee Payment Details (Subject to verification) RegistrationId 51100313182 TransactionId IK24519745 Transaction Date 25-02-2013 Fee Paid (in Rs) 100 Agency Name State Bank of India Mode of Payment Internet Banking

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