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Common Written Examination for Recruitment of Clerks - (CWE - Clerks-III)

38032
Registration # : 1251656471

Full Name :

SANDEEP KUMAR CHAT URVEDI

Category : If Person with Disability : Type of Disability : Percentage of disability :

GENERAL NO -

Do you intend to use the services of a scribe NA (only for VI and OC whose writing speed is affected by cerebral palsy) ? : Whether are you a Children/Family Members of those who died in 1984 Riots? : Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989 ? : Do you belong to a Religious Minority Community? : Religion : Are you an Ex-Serviceman? : Are you a Disabled Ex-Serviceman (DISXS)? : Have you joined a Government job on the civil side after availing of the benefits given as an ex-serviceman?: Are you a Dependent of Serviceman killed in Action (DXS) ? : Are you seeking relaxation under widow / divorced women / women judicially Separated from their husbands and who are not re-married?: Whether Regular Employees of the Union Carbide Factory, Bhopal, retrenched from service (applicable to Madhya Pradesh state only)? : Have you applied for the CWE for Clerical Cadre held in November/ December 2011? : Have you applied for the CWE for Clerical Cadre held in December 2012? : Nationality / Citizenship : State/ UT applied for: State code : Centre of Examination : Personal Details : First Name : SANDEEP NO NO NO NO NO Indian Madhya Pradesh 29 Bhopal NO NO NO Hindu NO NO

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Middle Name : Last Name : Date of Birth : Age completed as on 01.08.2013 : Gender : Husband's Name : Father's Name : Mother's Name : Address for correspondence : KUMAR CHATURVEDI 04-08-1991 21 MALE SHIVA DATT CHATURVEDI ASHA CHATURVEDI 213 D2 TYPE A SECTOR PIPLANI BHEL BHOPAL District : State : Pin code : Permanent Address : BHOPAL MADHYA PRADESH 462022 213 D2 TYPE A SECTOR PIPLANI BHEL BHOPAL District State : Pin code : Contact Details : Phone No. : Mobile No. : Email ID : Educational Qualification (as on 01.08.2013) : Exam Passed Graduation / Equivalent : Degree B.E Subject /Stream Engineering YES Certificate in Computer language NO Date of Passing 15-06-2012 % of Marks 70.60 Class / Grade First Class 9907046011 skrocky9@gmail.com BHOPAL MADHYA PRADESH 462022

Do you have Operating and working knowledge in computer systems : Details of Computer Knowledge : Do you have work experience? : Other Details : Whether desirous of taking Pre-Exam Training (Only for SC/ST/Religious Minority Communities/Ex-Servicemen/PWD): If Yes, Centre for Training : Details of Preference :

NA

1.Punjab National Bank 2.Union Bank of India 3.Bank of India

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4.Vijaya Bank 5.United Bank of India 6.Allahabad Bank 7.UCO Bank 8.Syndicate Bank 9.Punjab & Sind Bank 10.Oriental Bank of Commerce 11.Indian Overseas Bank 12.Indian Bank 13.Dena Bank 14.Corporation Bank 15.Central Bank of India 16.Canara Bank 17.Bank of Maharashtra 18.Bank of Baroda 19.Andhra Bank
Whether any prosecution/ detention/ fine/conviction/ sentence against you has been awarded by any court of law for any offence? : If yes, particulars of the same : Languages Known : Languages Known HINDI ENGLISH Read YES YES Write YES YES Speak YES YES NO

Application Fee / Intimation charges : Payment In : Amount : Reference ID : Transaction Date : ONLINE 600.00 MSBI3098946745 06-09-2013

DECLARATION :
I understand that in the event of any information being found untrue or incorrect at any stage/in the event any circumstances which may impair my fitness for employment in Banks/ organisation/ I do not satisfy any of the eligibility criteria stipulated, my candidature is liable to be cancelled.

Place:

Date: 06-09-2013

Signature of Applicant

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