Membership No : 510453631

Password : wd8bMKGP

Full Name : Mr. LEO CLINTON S

Name as to appear on Card : LEO CLINTON S

NO 1003MATHA KOIL STREET

SATHIPATTU POST
Office/Residential Address for communication :
PANRUTI
,CUDDALORE,PANRUTI,TAMILNADU607106

Date of Birth : 20-04-1996

Gender : Male

Qualification : Graduate

Specify : BACHELOR OF ENGINEERING(B.E.)

Bank/Institution working : STATE BANK OF INDIA.

Branch/Office : VRIDHACHALAM

Designation : CLERICAL STAFF

Date of Joining : 03-12-2018

Email : leoclintons@gmail.com

Mobile : 7639250230

ID Proof : ID Card issued by Employer(with Photo and Signature of Employee)

Aadhar Card Number : 810574604390

I agree to receive the Annual report from the Institute in a softcopy, at my registered email ID, in place
Yes
of physical copy :

ID Proof :

Signature :

Date : 20-02-2020 08:08:21 PM