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Pankaj Clerk Application

Pankaj Clerk Application

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Published by: Kalpesh Merani on Sep 23, 2011
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09/23/2011

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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR CLERICAL CADRE

26035
Registration # : 2002009544

Full Name :

Pankaj Jentibhai M erani

Category : If Person with Disability : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe (only for VI & OC both hands affected by cerebral palsy) ? : Whether you Children / family members of those who died in 1984 riots? : Whether you domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? : Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex-Serviceman ? : Are you a disabled Ex-Serviceman (DISXS)? : Are you a dependent of an Ex-Serviceman killed in action ? : Have you passed in one of the following Armed Forces Examinations equivalent to Civil Examination of HSc/Pre-University? : IAF Education Test for Promotion to rank of Corporal : Passing Out (Indian Navy) Examination conducted by Boys Training Establishment, Visakhapatnam :

OBC NO NA NO NO NO NO NO NO

NO NO

Are you a matriculate Ex-Servicemen candidate, who has obtained the Indian Army Special Certificate of Education or corresponding Certificate in the Navy or the Air NO Force after having completed not less than 15 years of service in Armed Forces of the Union? : 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)? : Nationality : State/ UT which the Centre of Examination Belongs : State / UT Code : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Name Of Payee Bank : Transaction No. : Branch Name : DP Code / Branch Code No : Deposit Date : CBS Bank of Baroda 120911500311408 jasdan 3349 12-09-2011 NO NO Indian Gujarat 21 Rajkot 137

Old Bus Stand At .00 kalpesh05@in.67 61.08.com 9276751077 Rajkot GUJARAT 360450 350 DECLARATION: I hereby declare that all statements made in this application are true.2011): Exam Passed SSC/Equivalent : HSC/Equivalent : Graduation/Equivalent : Post Graduation/Equivalent : Others : Other Details : Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ ExServicemen /PWD) : If Yes.29 62.42 60. Place: Date: 17-09-2011 Signature of Applicant Please retain your Registration No.14 65. Old Bus Stand At .08. Merani Matva Street Nr.BHAYAVADAR District State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01. my candidature is liable to be cancelled.BHAYAVADAR District State : Pin : Permanent Address : Rajkot GUJARAT 360450 C/o Dipak M. complete and correct to the best of my knowledge and belief.2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 26-07-1982 29 MALE Jentibhai Jayshreeben C/o Dipak M. Centre for Training : Languages Known English Hindi Gujarati --Read YES YES YES Write YES YES YES Speak YES YES YES Subject /Stream Genaral Commerce B com M com DCS Date of Passing 12-06-1997 25-06-1999 15-06-2002 01-07-2004 17-07-2005 % of Marks 62. Merani Matva Street Nr.2/3 Amount : Personal Details : Date of Birth : Age completed as on 01. I understand that in the event of any information being found untrue or incorrect at any stage or my not satisfying any of the eligibility criteria stipulated. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to IBPS .

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