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Indian Oil Corporation Limited

(A Government Of India Undertaking)

Application form (Personal & Confidential)

Please take the print out of the application form in A4 size portrait format only GATE Reg. No. # Indianoil Reg. No.# Date Post Applied Candidate's Name Father's / Husband's Name Relationship Date of Birth Gender Choice for Interview Centre Contact No Email Id Are You presently in Employment with IOCL Category Name of Caste/Community Date of Issuing Caste cert. State of Origin / Domicile Religion Whether belong persons with Disabilities(PWD)? Whether Ex-Serviceman Domiciled in JK (between 01.01.1980 and 31.12.1989) Marital Status Discipline Applied For Discipline Code Address for Correspondence Address1 : ROOM NO 329 Address2 : JCB HOSTEL DCE CAMPUS City / Town : NEW DELHI State : DELHI Pincode : 110042 Nearest Railway station Date: : PATNA Signature: DUSADH 22-08-2006 : BIHAR : Hindu : No : No : No : Unmarried : Computer Science : CS Permanent Address if different from above Address1 Address1 City / Town State Pincode : 775/B LOCO COLONY : OPPOSITE RAIL NEER PLANT KHAGAUL : PATNA : BIHAR : 801105 : CS-3121-1337 : 187071 : 27-12-2012 : Officers : Mr.SUMIT KUMAR : LALU RAM : Father :07-06-1992 : Male : Delhi : 8287384936 : sumit2k9dce@gmail.com : No : SC

Paste your recent self attested Passport size photograph and it should be the same as submitted along with GATE Application form

Caste cert. issuing authority DISTRICT MAGISTRATE

All the information given in this application form are true to the best of my knowledge and belief. If any of the information is found incorrect, my candidature may be cancelled. CANDIDATE TO PLEASE NOTE: 1. Please note your IOCL registration no. for future reference 2. Please visit our website after about 3 weeks of declaration of GATE 2013 result for further information. 3. Please retain the photograph uploaded for GATE 2013 application. If you are shortlisted for further selection process. Same photograph may be required to be uploaded. 4. Mobile no. and email ID mention in this application form should remain valid for at least next one year. 5.You may contact our helpline number 1860 354 0112 or write to us at recruit2013@indianoil.in