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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR CLERICAL CADRE

29030
Registration # : 2004654800

Full Name :

Ashwita Narayan Mi jar

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 :

GENERAL 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 230911s00333872 dombivali branch 0733 23-09-2011 NO NO Hindu Maharashtra 30 Mumbai 171

2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 05-04-1992 19 FEMALE Narayan Mijar Amani Mijar 4th Flr Room No 31 Kanha Sadan 2 Near Amba Bhavani Temple Kopar Road Dombivali West District State : Pin : Permanent Address : Thane MAHARASHTRA 421202 4th Flr Room No 31 Kanha Sadan 2 Near Amba Bhavani Temple Kopar Road Dombivali West District State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.2011): Exam Passed SSC/Equivalent : HSC/Equivalent : Other Details : Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ ExServicemen /PWD) : If Yes.76 67.08.com 9920783603 Thane MAHARASHTRA 421202 350 DECLARATION: I hereby declare that all statements made in this application are true. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to IBPS . Centre for Training : Languages Known English Hindi Marathi Tulu Gujrati --Read YES YES YES NO NO Write YES YES YES NO NO Speak YES YES YES YES YES Subject /Stream all commerce Date of Passing 13-03-2008 24-02-2010 % of Marks 62. my candidature is liable to be cancelled. 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. Place: Date: 23-09-2011 Signature of Applicant Please retain your Registration No. complete and correct to the best of my knowledge and belief.08.17 ashwitamijar@gmail.2/3 Amount : Personal Details : Date of Birth : Age completed as on 01.

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