West Bengal State Electricity Distribution Company Limited

(Government of West Bengal Enterprise)

FORMAT FOR APPLICATION AGAINST THE NOTIFICATION NO. MPP/2013/02
1. 2. 3. 4. 5. 6. 7. 8. 9. Name of the post Applied for Name of the Candidate (in block letters) Fathers / Husbands Name Mailing Address with Mobile No. Permanent Address Contact Telephone No. E-mail ID Date of Birth & Age as on 01.01.2013 Nationality : : : : : : : : : : : Examination Passed Name of the Board/ Institute/University/ Licensing Authority Year of Passing Division /Class Course Mode Full time/Part time/Others
AFFIX SELF AT T E S T E D PASSPORT SIZE PHOTOGRAPH

10. Marital Status 11. Qualifications

Qualification

a) Academic

b) Professional

12. Whether belongs to SC / ST / OBC (A) / OBC (B) /Physically Challenged Category [Copy of certificate(s) to be enclosed] 13. Present Place of Posting & Designation

: :

14. Date of confirmation in the Companys Service (Confirmation Order to be enclosed) 15. Particulars of Bank Draft (i) Name of the Bank & Branch (ii) Bank Draft No. & Date (iii) Amount 16. Documents / Credentials enclosed

: : : : ` :

D E C L A R A T I O N I, hereby, declare that the particulars furnished herein are true to my knowledge. If any information is found to be false subsequently by the authority, my candidature for the post is liable to be rejected. Date: Signature of the Candidate

Signature of the Controlling Officer With Office Seal