Apdf A 1836277 e 1 U 1328485

G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS

WEST BENGAL GROUP D RECRUITMENT BOARD
APPLICATION FORM FOR THE POST OF GROUP D IN WEST BENGAL (2017)
A3B5E58BE848D90306ACB1385B1EA2A681F21FF9A06D23249E0E3E5A277CBD43

101836277MG860217A
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
Application G860217NSS
Sl. No. 101836277
G860217NSS
To G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
The Chairman
G860217NSS
West BengalG860217NSS G860217NSS
Group D Recruitment Board G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
Utility Buildings, Action Area IIC,
(Near Mangaldeep
G860217NSS Rotary), New
G860217NSS Town, Kolkata-700161
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
Sir,
I hereby apply for the post of GROUP D (2017). Necessary particulars are furnished below:-
Post applied for : GROUP D (2017)
G860217NSS G860217NSS
Advertisement No G860217NSS G860217NSS
: WBGDRB Dated 01.01.2017 G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
Name in FullG860217NSS G860217NSS
G860217NSS : SOUMEN DAS
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
Gender : Male Category : UR Date of Birth : 17/02/1986
Indian : Yes Persons with Disability (PWD) : Not Applicable
Father's / Husband's Name : KISHORI MOHAN DAS
G860217NSS G860217NSS G860217NSS
Mother's Name G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
: MADHURI DAS
ExService-Men
G860217NSS : No
G860217NSS G860217NSS Service Experience
G860217NSS Details G860217NSS
G860217NSS : Year G860217NSS
Month Days
G860217NSS G860217NSS
00 00 00
Sports Quota - Participated in : Games/Sports :
Tournament
Mobile : 9932951639 Email : soumen.das17@gmail.com
Complete Mailing Address :
VILL-RAYRAYNACHAK
PO : PITAMBARCHAK
POLICE STATION
G860217NSS G860217NSS G860217NSS : HALDIA G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
G860217NSS
DISTRICT : PURBA
G860217NSS G860217NSS G860217NSS MEDINIPUR
G860217NSS PIN : 721657G860217NSS G860217NSS G860217NSS G860217NSS
G860217NSS
STATE : WEST
G860217NSS G860217NSS G860217NSS BENGAL
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
Permanent Address :
VILL-RAYRAYNACHAK
PO : PITAMBARCHAK
POLICE STATION : HALDIA
DISTRICT : PURBA MEDINIPUR PIN : 721657
STATE : WEST BENGAL
Educational Qualification : Class VIII Pass : Yes
Name of Examination
Year of Passing (YYYY) Name of the School / Board / Council / University
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSSW.B.B.S.E.
Class VIII 2001 G860217NSS G860217NSS G860217NSS
HIGHER SECONDARY (CLASS 2005 W.B.C.H.S.E.
G860217NSS G860217NSS
10+2) G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS Page

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1 of 2
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Application Sl. G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS
No. 101836277
101836277MG860217B
Name : SOUMEN DAS A3B5E58BE848D90306ACB1385B1EA2A681F21FF9A06D23249E0E3E5A277CBD43

Do you belong to exempted category? : NO Registration & NCO No. issued by the
G860217NSS G860217NSS G860217NSS G860217NSSlabour department, Govt.
G860217NSS of W.B. :
G860217NSS G860217NSS G860217NSS G860217NSS
Opted Language Paper : BENGALI
Religion : HINDUISM
Declaration :
(i) I possess all the Essential Qualifications for the Post.
G860217NSS G860217NSS
(ii) I solemnly G860217NSS
declare that all G860217NSS
statements made G860217NSS
in this application form are G860217NSS G860217NSS
true, complete and G860217NSS
correct to the G860217NSS
best of my knowledge
and belief. In the event of any information being found suppressed / false or incorrect, or if my ineligibility is detected before,
G860217NSS G860217NSS
during or after the tests G860217NSS G860217NSS
and medical examination, G860217NSS
my candidature G860217NSS
/ appointment G860217NSS
will stand cancelled andG860217NSS G860217NSS
my claim to recruitment
will stand forfeited. I also declare that I have submitted no other application form for this examination.
Place : HALDIA Yours faithfully,
Date : 24 JanG860217NSS
G860217NSS 2017 10:58:00 G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS

Full signature of the candidate
G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS G860217NSS Page

G860217NSS
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