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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR SPECIALIST OFFICERS

34035
Registration # : 3000396706

Full Name :

Ajit Yadav

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: Online Ref ID : 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 Rajasthan 39 Jaipur 139

ONLINE MPNB2674224883 450

01-09-1987 24 MALE Shiwpujan Singh Yadav Dhaneshwari Yadav House No.-67 Dadabari Extension Chota Chauraha

District State : Pin : Permanent Address :

Kota RAJASTHAN 324009 Vill+po-burhanpur

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District State : Pin : Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.12.2011): Exam Passed Graduation: Degree B.E. Subject /Stream Electronics & Telecommunications Date of Passing 14-05-2010 % of Marks 62.40 Class / Grade First Class ajity2@gmail.com 8233342677 Ghazipur UTTAR PRADESH 275203

As on date for Post Qualification Work Experience should be 01.12.2011 Name of the Employer & Nature of Employment Total Experience (in months) : Languages Known Hindi English Read YES YES Write YES YES Speak 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. complete and correct to the best of my knowledge and belief. 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, my candidature is liable to be cancelled.

Place:

Date: 18-01-2012

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