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ON-LINE APPLICATION FOR RECRUITMENT OF APPRENTICE DEVELOPMENT OFFICERS-2012-13

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Registration # : 1233813

Full Name : Anuradha Malhotra

Category : GENERAL
Type of Applicant : Others

Are you an Ex-Serviceman ? : NO

Zone : Northern Zone
Zone Code : 01

Choice of Division : CHANDIGARH

Division Code : 104
Choice of Examination Centre : CHANDIGARH
Centre Code : 104

Applied For : Urban

Nationality : Indian

Personal Details :
Date of Birth : 13-11-1990
Age completed as on 01.11.2012 : 21
Gender : FEMALE
Husband's Name:

Father's Name : Umesh Kumar Malhotra

Mother's Name : Renu Bala

Correspondence Address :
Address for Correspondence : 1449
Sector 61
Chandigarh
District Chandigarh
State : CHANDIGARH

Pin Code : 160062

Permanent Address : 1449

Sector 61
Chandigarh
District Chandigarh
State : CHANDIGARH
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Pin Code : 160062

Contact Details :
Phone NO: 0172-2682118
Mobile No : +919464545156
Email ID : anuradham77@gmail.com

Qualification Details :

Exam Passed Subject / University/Board Year of Passing % of Marks Class / Grade

Stream
Graduation /
Equivalent (as on btech ptu 01/06/2012 82.14 First Class
01.11.2012):

Work Experience:
Salary Roll(SR) No :
Designation :
Office :

Date of Appointment :
Date of Confirmation :
Period Of Service after Confirmation in Months :
Have you completed 3 years of service after confirmation in Class III post
Agency Code No :

Date of Appointment :
Branch Office :

Business Performance Details :

Sr No Agency Year Net First Year's No of Lives

Premium

Have you completed not less than 5 years as an agent and has brought a net First Years
Premium Income of not less than Rs. 5,00,000/- during the immediately preceding 5 agency
years and a net First Year Premium Income of not less than Rs. 1,00,000/- on 50 lives in
each of any 3 of these agency years?
Have you completed not less than 4 years as an agent and has brought a net First Years
Premium Income of not less than Rs. 1,00,000/- on 50 lives per year in any 3 of the
immediately preceding 4 agency years?
If Related to any Agent/Employee/Officer/Medical Examiner etc. LIC of India Please State :
His / Her Name :
Designation :
Place of Posting / Working :
Exact Relationship :

Languages Known Read Write Speak

English YES YES YES

Details of Pre-Exam Training

Would you like to undergo Pre-examinationTraining:(Only for SC/ST)

Place:
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Date: 17-12-2012 Signature of Applicant
Declaration

I hereby declare that all statement made in this application are true and correct to the best of my knowledge and belief. I understand that in
the event of any information being found false or incorrect or not satisfying the prescribed eligibility criteria for the post applied for ,my
candidature is liable to be cancelled/rejected at any stage of selection.

Please retain your Registration No. and Password emailed to you carefully for further reference
NOTE: Please DO NOT SEND application printout to IBPS