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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR SPECIALIST OFFICERS

22043
Registration # : 3000337213

Full Name :

ARABINDA PARIDA

Post : Post Code : 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? : Are you an Employee of any participating Bank ? : Name of the Participating Bank : Employee Number : Are you an Ex-Serviceman ? Nationality / Citizenship : 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 : Amount : Personal Details : Date of Birth : Age completed as on 01.12.2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence :

I.T.Officer (Scale-I) 01 OBC NO NA NO NO NO --NO INDIAN Karnataka 26 Bangaluru 126

CBS Bank of Baroda 160112S001302147 MARTHAHALLI 3193 16-01-2012 450

27-07-1989 22 MALE ALEKHA CHARAN PARIDA SHANTILATA PARIDA #21 SLV RESIDENCY SAPTAGIRI LAYOUT MUNEKOLALLA MARATHAHALLI

com 8880556477 BANGALORE KARNATAKA 560037 AT/PO-LENKUDIPADA NAYAGARH ORISSA 752070 As on date for Post Qualification Work Experience should be 01. my candidature is liable to be cancelled.2/2 District State : Pin : Permanent Address : District State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.12. complete and correct to the best of my knowledge and belief.53 Class / Grade First Class First Class First Class parida. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to IBPS .arp. 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: 18-01-2012 Signature of Applicant Please retain your Registration No.2011 Name of the Employer & Nature of Employment Total Experience (in months) : Languages Known ENGLISH HINDI ORIYA Read YES YES YES Write YES YES YES Speak YES YES YES Designation and Rank if any From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Remark(Reason for Leaving) Years of Service (YY/MM) DECLARATION: I hereby declare that all statements made in this application are true.80 70.12.72 72.2011): Exam Passed Graduation: Others1 : Others2 : Degree B.arabinda@gmail.Tech Others-CHSE OBSE Subject /Stream Computer Science Date of Passing 01-05-2011 01-05-2006 01-05-2004 % of Marks 68.

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