9/21/2020

REGISTRATION SLIP

APPLICATION NO : 41142569

CANDIDATE NAME : KABYASHREE DIPTIMAYEE SWAIN

ARE YOU INDIAN CITIZEN: YES

ARE YOU BIS EMPLOYEE : NO

POST APPLIED FOR : ASSISTANT SECTION OFFICER

FATHER'S NAME DIBAKAR SWAIN MOTHER'S NAME JYOSHANARANI SWAIN

EMAIL ID KABYASHREESWAIN20@GMAIL.COM MOBILE NO 9348074621
DATE OF BIRTH : 20-Jul-1997 AGE : 23 YEARS, 2 MONTHS, 6 DAYS
GENDER FEMALE MARITAL STATUS SINGLE
CATEGORY GENERAL (UR) RELIGION HINDU
WHETHER BELONG TO MINORITY : NO
ARE YOU A PWBD/PWD CATEGORY WITH 40 % OR
NO
MORE PERMANENT DISABILITY? :
WHETHER EX-SERVICEMAN : NO
PERMANENT ADDRESS : RAMDAS PUR, RAI PUR, BALICHANDRA PUR, ODISHA, JAJPUR, 754292
CORRESPONDENCE ADDRESS : NEAR SAKTI MARBLE, RANGOLI CHAWK, FERTILIZER, ODISHA, SUNDERGARH, 769007

EDUCATIONAL QUALIFICATIONS

QUALIFICATION ACQUIRED / NAME OF THE BOARD/COUNCIL/UNIVERSITY TO

SUBJECTS YEAR OF PASSING PERCENTAGE OF MARKS
EXAMINATION PASSED WHICH THE INSTITUTION IS AFFILIATED

CLASS X DETAILS BSE ODISHA ALL 2012 90.33

CLASS XII DETAILS CHSE ODISHA PCMB 2014 56.83

GRADUATION SAMBALPUR UNIVERSITY CBZ 2017 57.73

POST GRADUATION CENTURION UNIVERSITY BOTANY 2020 80.75

ARE YOU COMPUTER PROFICIENT UPTO LEVEL-6 OF NATIONAL SKILL QUALIFICATION FRAMEWORK YES

TEST CENTER PREFERENCE

Test Center Choice 1 BHUBANESWAR

Test Center Choice 2 PATNA

Test Center Choice 3 VISHKHAPATNAM

DOCUMENTS AND PHOTOGRAPH UPLOAD

Photograph Uploaded

Signature Uploaded

Date of Birth Certificate / Class X certificate Uploaded

Class 12th Certificate Uploaded

Graduation Degree Certificate Uploaded

Post Graduate Degree/Masters Degree Certificate Not Uploaded

Experience Certificate Not Uploaded

ID Proof Uploaded

NSQF Level Certificate Uploaded

PAYMENT DETAILS

Amount Paid Payment Status Transaction Number Transaction Date

Rs 0 Success NA 2020-09-21 08:16:03 AM

I have carefully read the advertisement No 02/2020/ESTT Dated 05.09.2020 of BIS and certify that the information furnished above is correct to the best of my knowledge and no material information relevant to my
candidature has been suppressed or falsely declared. I am meeting all the advertised specifications for the post applied for. I understand that if the information furnished by me is found to be incorrect/false or not supported
by documentary proof or not meeting the eligibility criteria mentioned in the advertisement, my candidature is liable to be rejected even after shortlisting.

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