ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR CLERICAL CADRE

21034
Registration # : 2000009145
Full Name : Mehdi Hassan
Category : OBC
!f Person with Disability : NO
Type of Disability : -
Percentage of Disability : -
Do you intend to use the services of a scribe
(only for v! 8 OC both hands affected by cerebral palsy) ? :
NA
Whether you Children f family members of those who died in 198+ riots? : NO
Whether you domiciled in Kashmir Division of the State of
J8K during the period 1-1-1980 to 31-12-1989? :
NO
Whether you belong to Religious Ninority Community ? : YES
Religion to which you belong : Nuslim
Are you an Ex-Serviceman ? : NO
Are you a disabled Ex-Serviceman (D!SXS)? : NO
Are you a dependent of an Ex-Serviceman killed in action ? : NO
Have you passed in one of the following Armed Forces Examinations equivalent to Civil
Examination of HScfPre-University? :
!AF Education Test for Promotion to rank of Corporal : NO
Passing Out (!ndian Navy) Examination conducted by Boys Training Establishment,
visakhapatnam :
NO
Are you a matriculate Ex-Servicemen candidate, who has obtained the !ndian Army
Special Certificate of Education or corresponding Certificate in the Navy or the Air
Force after having completed not less than 15 years of service in Armed Forces of the
Union? :
NO
Are you seeking relaxation under widow f divorced women f women judicially
Separated from their husbands and who are not re-married? :
NO
Whether Regular Employees of the Union Carbide Factory, Bhopal, retrenched from
service (applicable to Nadhya Pradesh state only)? :
NO
Nationality : !ndian
Statef UT which the Centre of Examination Belongs : West Bengal
State f UT Code : +5
Centre of Examination : Kolkata
Centre Code : 218
Application Fee J Intimation Charges details:
Payment Node: ONL!NE
Online Ref !D : N!DS0885210+61
Amount : 350
Personal Details :
Date of Birth : 09-10-1986
Age completed as on 01.08.2011 : 2+
Gender : NALE
Husband's NamefFather's Name : Ruhal Amin
Nother's Name : Jyotsnara Begum
Address for Correspondence : +0f1-Ekdilshah Road
Kazipara(N)
Barasat North 2+-Parganas
State : WEST BENGAL
Pin : 70012+
Permanent Address : +0f1-Ekdilshah Road
Kazipara(N)
Barasat North 2+-Parganas
State : WEST BENGAL
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Pin : 70012+
Contact Details :
Email !D : mehdi.hassan.eng@gmail.com
Phone No : 033-25526885
Nobile No : 9038+81863
Qualification Details {as on 01.0S.2011):
Exam Passed Subject JStream Date of Passing % of Marks
SSCfEquivalent : All 31-07-2002 67.75
HSCfEquivalent : Science 30-06-2005 72.+0
GraduationfEquivalent : ECE 31-07-2009 68.00
Other Details :
Would You like to undergo Pre-Exam Training (SCfSTfNinority Communityf Ex-
Servicemen fPWD) :
NO
!f Yes, Centre for Training : --
Languages Known Read Write Speak
English YES YES YES
Bengali YES YES YES
Hindi YES YES YES
DECLARATION:
! hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. ! 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, my candidature is liable to be cancelled.
Place:
Date: 25-0S-2011 Signature of Applicant
Please retain your Registration No. and Password emailed to you carefully for further reference
NOTE: Please DO NOT SEND application printout to IBPS
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