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BEL : PROBA T IONA RY ENGINEERS(PE) - GA T E 2013 A pplic a t io n Fo r m A pplica t ion No.

: 211546 *

* A pplica t ion f or t he Post of : PR O BA TIO NA R Y ENGINEER S(PE) - Ele ct ronics

Per s onal Par t icular s
* * Na me (a s it a ppe a rs in Mr. A R A VIND R y our SSLC /SSC ce rt if ica t e ) A ddre ss f or C ommunica t ion 37/1 A R A J A GA NA PA THY NA GA R , HA STHA MPA TTY(PO ST), SA LEM

* C it y /Dist rict * St a t e * C ont a ct No. wit h STD C ode

SA LEM TA MIL NA DU 427 -2419996 SA LEM MA LE 14-Ma r-1991 HINDU a ra v indnsit @gma il. com

* Pin C ode

636007

Mobile No * Na t iona lit y

7200738527 INDIA N

* Ne a re st R a ilwa y St a t ion * Ge nde r * Da t e of Birt h * R e ligion * E-ma il ID

A lt e rna t e E-ma il ID, if a ny a rv indbe . in@gma il. com

Qualificat ions Det ails
* Engine e ring De gre e * Inst it ut ion B. E. NA R A SUS SA R A THY INSTITUTE O F TEC HNO LO GY * Mont h & Ye a r of Pa ssing * Pe rce nt a ge / C la ss in Engine e ring De gre e A pr-2012 72. 9 /F irst Ele ct ronics & C ommunica t ion 12162325

* Engine e ring De gre e St a t us Pa sse d * Bra nch * GA TE 2013 R e gist ra t ion No.

Employ ment Det ails
* A re y ou Employ e d? If Ye s, Ty pe of O rga nisa t ion De signa t ion NO Na me of t he O rga nisa t ion Pa y Sca le (C TC f or ot he rs)

Gener al Infor mat ion
* C a t e gory A re y ou a Domicile of J &K * During 1. 1. 1980 t o 31. 12. 1998? SC NO

Indica t e bra nch of A rme d f orce s a nd da t e of discha rge (DD/MM/YYYY) NO If Ye s. . A pplica t ion No. Ple a s e c he c k . 211546 Pla ce Da t e Kindly s a v e t his pa ge by us ing pr int o ut . Signa t ure of A pplica nt (To be signe d prior t o de spa t ch) 'SA VE A S' o pt io n giv e n in t he br o ws e r be fo r e t a k ing t he Print (Ple a se Print t he f orm f or F urt he r R e f e re nce ) A n a c k no wle dge m e nt m e s s a ge ha s no w be e n s e nt t o y o ur giv e n Em a il. * C ha lla n A mount * C ha lla n Da t e * SBI Ba nk Bra nch Na me De cla ra t ion I he re by de cla re t ha t I ha v e v e rif ie d t he de t a ils indica t e d a bov e a nd a lso conf irm t ha t a ll t he inf orma t ion submit t e d is corre ct t o t he be st of my knowle dge .* A re y ou a Pe rson wit h Disa bilit ie s (PWD)? A re y ou a n Ex Se rv ice ma n? If Ye s. A t a ny st a ge . a s de e me d f it . if it is f ound t ha t a ny of t he a bov e inf orma t ion is incorre ct a nd/or is suppre sse d.ID. t he ma na ge me nt of BEL sha ll ha v e t he right t o t a ke a ct ion. Indica t e t y pe of disa bilit y a nd Pe rce nt a ge of disa bilit y Se rv ice in De f e nce % 0 Ye a rs 0 Mont hs * NO Int er v iew Tes t Cent er * Int e rv ie w Te st C e nt e r Ba nga lore Challan Det ails (if not exempt ed) * J ourna l No.

Lo di Ro a d. A pplica t ion F orm re ce iv e d wit hout t wo phot ogra phs. O rigina l ce rt if ica t e s of t he short list e d ca ndida t e s will be scrut iniz e d / v e rif ie d a t t he t ime of int e rv ie w. 2. A t t a ch y our pa ssport siz e phot ogra ph (wit hout a t t e st a t ion) in t he spa ce prov ide d be low. 4.: 211546 Na me : A R A VIND R A ddre ss: 37/1 A R A J A GA NA PA THY NA GA R . A pplic a t io n No . SA LEM SA LEM -636007 TA MIL NA DU Signa t ure of A pplica nt (in t he spa ce prov ide d) . 3. Ne w De lhi. signa t ure s a t t wo pla ce s will be re je ct e d. HA STHA MPA TTY(PO ST). 5. Se nd t he duly comple t e d A pplica t ion f orm a t t he f ollowing a ddre ss on or be f ore 31 M a r c h 2013 : Po s t Bo x No . Endorse y our signa t ure s in t he spa ce prov ide d be low.110003.Im po r t a nt Ins t r uc t io n fo r Ca ndida t e s : 1.3076. Do NO T se nd a ny copy of t he ce rt if ica t e a longwit h t he duly comple t e d a pplica t ion f orm.

------------------------------------- -------------------------- .GATE 2013: Applic a tion for the Post of PROBATIONARY ENGINEERS(PE) Discipline: Electronics To POST BOX NO. 3076 .Ple a se C ut & A f f ix t he A ddre ss La be l giv e n be low on t he e nv e lop f or se nding print v e rsion of O nline A pplica t ion F orm a t t he f ollowing a ddre ss on or be f ore 31 M a r c h 2013 : ------------------------------------- -------------------------- BEL. NEW DELHI-110003. LODI ROAD.