LIFE INSURANCE CORPORATION OF INDIA ‘aedta oraierr CENTRAL OFFICE rater art, yay - 400021. *YOGAKSHEMA", JEEVAN BIMA MARG, MUMBAI - 400021. arerana ue afters war or BIO-DATA-CUM INDENTITY CERTIFICATE 0 Rott No. [TTT [eek re altel hes) a Sei TTT J earns feet T POSTAL ADDRESS FOR CORRESPONDENCE Ty ferats pincooe [TT wee fe ‘Sage F. MOBILE Sf. 3. eecheh we wea LANOUNE WITH STD CODE Revere Ss ml (a) latelelel=[ =|] LITT TTIT1 ea eat eo PERMANENT ADDRESS ferste PINCODE afte DATE OF BIRTH (Fevers) (ODIMMIYY) =e PLACE OF BIRTH L L ot eee ESis=eiicl=| CI a0) fer sex WPUMALE | ft FEMALE ‘trates feat ae. “afearten a aaa eo MARITAL STATUS UNMARRIED. ommens _|_No-OFCHILDAEN Grenyt ari (7) Ft) (i= = (Tick whichever applicable) Reavers FATHER'S / HUSBAND'S NAME "THE OCCUPATION TT TT I it aa | aa, | ane caTecony, cenena| “so 080 a eae iv) st) = (A) (Tick Whichever Applicable) cafe mn /3k oT /SH Rea. eh seen set IFSC/ST/OBC MENTION SUBCASTE seaccaoeet, ape eta aa a IF MINORITY, MENTION COMMUNITY RAPPLICABLE) (6) (TICK WHICHEVE! © See2 are fewest, wt fore cey ar faeries are Freee et IF PHYSICALLY HANDICAPPED, MENTION DEGREE AND NATURE OF DISABILITY IN BRIEF a CONFIRMATION] Tear 7 ae veeether F] Fro wre Fa] DESIGNATION POSTED AT MONTH & YEAR (Name of office) OF JOINING UC exam NAME OF — | GRADE | PERCEN | MAIN YEAROF|NO.OF | OTHER BOARD / TAGE | SUBJECTS —_| PASSINGJATTEMPTS | INFORMATION 15. seat a er ao LANGUAGES KNOWN, READ WATE17, phere rot 9, whe fret saree 3 ar fre float STE wa er re ere ere ‘ert, ree re rere Wa aT PTT Have you ever been prosecuted, detained, fined, convicted or awarded YES/NO any sentence by any court of law for ‘any offence or any case is pending against you ea) Iso, please give details. 4g, eh feet are ot Corer erect Feat i fr sees aera 78, PAT | ‘Name and address of Two references (indian National only) not related to the candidate, sates ——— rere arg fr er ori terre gem farce Shree et Fre Bs TE Tew, te ean rea Fr a rer eee zene re greet eee ere fl Fe er rt fee er tte ee TERT A | (Shei / Smt. / Ms. hereby declare that the information / particulars ‘given by mo in this application is/are true to the best of my knowledge and belie! and if found to be otherwise, | shail be fiable to any such action as the Life Insurance Corporation of india may deem fit to take. | also accept ‘that such decision of the Corporation in all matters shail be final and binding on me. arte & FATT Signature of Applicant rt yt4 ‘afters ware ar IDENTITY CERTIFICATE ear fare et tatty aver This is to certiy that Shri/Smt,/Ms, Son/Daughter / Wife a whet at of Shri isknown tome forthe past yearsand sabe 8 rae re heer fre sarge eer en Fre et months and the particulars furnished by him / her are correct to the best of my belief. Teer Signature Figs 4 ‘Rr / Seal ‘afer ro Fae TH a Herat ow Bae eRe saenret weer Be ce a eter rE aT | 5 Rye war rene ster 1. sete ate der Fre ne eh stead 1 Uae ie wre 9 ait seme det mete 1 arvana afer | 1B edhrecat metre, fre rede ert wt ab ee fry weg fre Te) vanes fer | Identity Certiicate : The Identity Certificate should be certified by any one of the officials listed below and rubber stamp ‘ofthe certtying official should be atfixed below the signature a) Gazetted Officer of Central StateGo.—g) ager: Ba cee sree fers 1 aE Shere fear ee |e see fed, Bae, aera ATE | % BTW. C2, a rey We Reeve ar He sre Feret| Sereet rate es area fer ew TC ver fos ate he ret 2 FIRTH. te, toB, tu, Le MMT Re HAT: Sree eer we ee eT HTTe are ere hc ee, mer et re a 9 en eet ree fered 1 fe fe sr Be ore fe afer re a sarerrrere woh Frere er ara Te fer 1 INSTRUCTIONS ; Please write all particulars / information in CAPITAL LETTERS. Do not leave any column blank, Do not put dashes. give ‘specific reply, ie. Yes/NoINWN, A. etc: 1. ForCol. Nos. 1, 2,4, 6and 9 ‘Write each alphabet the box provided. Leave one Box between two words. Furnish full postal address with Pin Code. 2. Forcol No, 5, 10, 108, 14, 16 and 17 Bring Original and one set of photostat copies of all certificates at the time of interview. Original certificate will be ‘returned after verification and photostat copies willbe retained with us. 3. Give brief and correct answers. Ifthe reply to any question needs more space, details should be given in separate sheet of paper,