You are on page 1of 3

Welcome to Life Insurance Corporation of India - Application Form Print

http://ibpsreg.sifyitest.com/licaao_feb13/registration_print.php?regno=...

RECRUITMENT OF ASSISTANT ADMINISTRATIVE OFFICER

ON-LINE APPLICATION FOR Life Insurance Corporation of India - RECRUITMENT OF ASSISTANT ADMINISTRATIVE OFFICER

Last Modified On: 30-03-2013

No Of Times Modified: 1

25027
Registration # : 2126635

Full Name :

Raghu T S

Category : If Person with Disability : Type of Disability : Percentage of Disability :

ST NO -

Do you intend to use the services of a scribe NA ( only for VH and OH candidates whose writing speed is affected by cerebral palsy)?: Are you an ECO/SSRCO ? : Are you a Confirmed Employee of LIC ?: SR No.: Designation: Place of Posting: Whether you belong to Religious Minority Community ? : Minority Religion : State/ UT which the Centre of Examination Belongs: Centre of Examination : Centre Code : Nationality : Application Fee / Postal Charges Details : payment in: Amount : Reference ID : Transaction Date : Personal Details : Date of Birth : Age completed as on 01.03.2013 : Gender : Marital Status : Husband's Name : Father's Name : Subbarayappa 01-06-1982 30 MALE Unmarried ONLINE 50.00 MHCC2957191375 30-03-2013 NO Karnataka BANGALORE 179 Indian NO NO

1 of 3

3/30/2013 10:57 PM

Welcome to Life Insurance Corporation of India - Application Form Print

http://ibpsreg.sifyitest.com/licaao_feb13/registration_print.php?regno=...

Mother's Name : Address for Correspondence :

Nagalakshmamma No 724 1st Floor 13th B Main EWS 2nd Stage Yelahanka New Town

District State : Pin : Permanent Address :

Bangalore KARNATAKA 560064 Thapaganadoddi Village Nagalamadike Post Pavgada Taluk

District State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.03.2012): Exam Passed Subject/Stream Date of Passing 20-07-2010 20-09-2012

Tumkur KARNATAKA 561202

raghutmkr@gmail.com +917411121521

aggregate marks obtained 3189.00 1861.00

maximum marks 5225.00 2400.00

% of Marks

Class / Grade First Class First Class

Graduation: Post Graduation:

BE MTECH

61.03 77.54

Post Qualification work experience details (Start from present Employer): Name of the Employer & Nature of Employment BTLITM Teaching Designation From(mm/yyyy) To(mm/yyyy) and Rank if any Lecturer 07/2012 03/2013 Nature of duties performed Remark(Reason for Leaving) Years of Service (YY/MM) 0/9

Teaching and Administrative work

better prospects

Total Relevant Experience : 9 Languages Known Hindi English Kannada Read YES YES YES Write YES YES YES Speak YES YES YES

DECLARATION:
I hereby confirm and declare that all the statements made and information provided by me in this Application are true, correct and complete to the best of my knowledge and belief. In the event of any information or the part of it being found false or incorrect before or after the recruitment process, action can be taken against me by the competent authority and my candidature/appointment will automatically be cancelled/terminated.

2 of 3

3/30/2013 10:57 PM

Welcome to Life Insurance Corporation of India - Application Form Print

http://ibpsreg.sifyitest.com/licaao_feb13/registration_print.php?regno=...

Place:

Date: 30-03-2013

Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference

3 of 3

3/30/2013 10:57 PM

You might also like