BHARAT ELECTRONICS LIMITED (A Government of India Enterprise under the Ministry of Defence) SMART CARDS / TAMIL NADU REGION

POST APPLIED FOR: ___________________________ Personal Particulars: 1. Name in full 2. Fathers Name 3. Address with Pin Code (a) Permanent : : : Phone No: Recent colour Passport size photo with Signature

(b) Correspondence

Phone No: E-mail ID:

4. Nationality

: : Yes / No

5. Do you belong to SC/ST/OBC community? If yes, name of the community & sub caste

6. Do you belong to PHP (Physically Handicap) category : Yes / No 7. Date of Birth & Age (as on 01.07.2011) :

8. Educational / Professional Qualification: (Indicate Division & year of passing from Matriculation onwards) EDUCATIONAL INSTITUTION/ SUBJECT / QUALIFICATION UNIVERSITY DISCIPLIN E CLASS PERCENTAG SECURED E OBTAINED YEAR OF PASSING

Contd . . . (2)

-29. Please give particulars of your relatives employed in this Company, if any : a) b) c) d) e) Name: Relationship: Designation: Department: Unit:

10. Knowledge of Tamil (Read, Write & Speak): Yes / No (please tick) 11. Experience: Name of the Organisation (a) Past Employment From To Total Service Designation Area of work

(b) Present Employment

12. Have you appeared for any Test / Interview for appointment in BEL? If so, please furnish details in brief.

13. Additional Information, if any.

The information furnished above is true to the best of my knowledge. If at any stage, the information furnished above is found to be false / concealed, my candidature / appointment to the post shall be summarily disqualified / contract terminated without assigning any reason.

DATE: PLACE:

SIGNATURE