1/2

Common Written Examination for Recruitment of Probationary Officers/ Management Trainees in 19 Public Sector Banks

19035

Registration #:

1000341046

Full Name:

Kapil Laxmidas Shah

Category : If Person with Disability : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe(only for VI and OC candidates whose writing speed has been affected by cerebral palsy) : Whether Children/Family Members of those who died in 1984 Riots? : Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? Whether you belong to Religious Minority Community? : Religious Minority Community to which you belong : Are you an Employee who has completed 5 years of service in RRBs ? : Are you an Ex-Serviceman : Nationality / Citizenship : State/ UT which the Centre of Examination Belongs: State code : Centre of Examination Centre code : Application Fee / Intimation Charges : Payment Mode : NEFT UTR No : Online Reference ID: Sending Bank Name : City : Deposit Date : Amount :

GENERAL NO --NA NO NO NO -NO YES Indian Gujarat 21 Ahmedabad 33

On line -MSDC1077958439 --22-07-2011 450

Personal Details :
Date of Birth : Age as on on 01.07.2011. : Gender : Husband's Name / Father's Name : 17-12-1986 24 MALE Laxmidas Gopalji Shah

2/2
Mother's Name : Address for Correspondence : Hastaben Laxmidas Shah Gopal Bhuvan Near Naresh Traders G.T Road Mandvi District State : Pin : Permanent Address : Kutch GUJARAT 370465 Gopal Bhuvan Near Naresh Traders G.T Road Mandvi District State : Pin : Kutch GUJARAT 370465

Contact Details:
Phone No : Mobile No: Email ID : Educational and Professional Qualification Details:(as on 01.07.2011) : 02834-230114 9998267040 kaps_0415@yahoo.co.in

Exam Passed
Graduation : Other Details :

Subject/Stream
BE Instrumentation

Year of Passing
2008

% of Marks
55.40

Whether desirous of taking Pre-Exam Training (SC/ST/ Minority Community) : If Yes Centre for Training :

---

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: 22-07-2011 Signature of Applicant

Kapil Laxmidas Shah

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please do not send the application printout to IBPS