08/12/2022, 16:59 NeL-2022 FORM Candidate Personal Details Candidate Photo Application status Application Number PaymentSuccess NcL1005497 Date of Birth Gender 12/Feb/1998 Male Father's Name Mother's Name BIYYANASHANKARAI —_BIYYANA PADMA AH Mobile Number Alternate Mobile Nu 7702904717 mber 9701278302 Post Details Post Name Post Code Mining Sirdarin Tech 01 nical and Supervisory Grade C Candidate Domicile and Category Details Nationality Reservation Categor Indian y Other Backward Class (Non Creamy Layer) Additional Details Are you an ExServic Are you a departme emen? ntal candidate (Emp No loyee of CIL and its S ubsidiaries)? No hitps:wow dgiaim com/EForms/SBINewAfterPaymentActon do?798612212582Zoniine Candidate's Name BIYYANA MANOJKUM AR Marital Status Unmarried Email ID biyyanamanojkumars 666@gmail.com Are you employed in Government/Semi- overnment/Autono mous Body or PSU(E xcept employee of C IL and its Subsidiari es? No 13osir212022, 16:59 Do you have valid M ig Sirdar/Overma n certificate of com petency issued by D GMS under Coal Min es Regulation 2017 0 any other certifica te in Mining which e ntitle the applicant to work as Mining Si rdar as per Coal Min es Regulation 2017? Yes Correspondence Address Address Line 1 H.NO 11-7-421/1205 City/District Others Is Permanent Addre ss Same as Correspo ndence address? Yes Permanent Address Address Line 1 H.NO 11-7-421/1205 City/District Others Name of the Board BOARD OF SECONDA RY EDUCATION Year of Comple 2014 Tech Qualification Degree Diploma Not.2022 FORM, Do you have valid G as Testing Certificat e Yes Address Line 2 SANTHOSH NAGAR, 81 NCLINE COLONY Other City/Village PEDDAPALLI Address Line 2 SANTHOSH NAGAR, 81 NCLINE COLONY Other City/village PEDDAPALLI Matriculation (10th) Details School/ Institute Na me SINGARENI COLLIERIE S HIGH SCHOOL -al Qualifications Details Institute passed fro m ANURAG ENGINEERIN G COLLEGE - KODAD hitps:wow dgiaim com/EForms/SBINewAfterPaymentActon do?798612212582Zoniine Do you have valid Fi rst Aid Certificate? Yes Country India State Telangana Pincode/Postal Code 505211 Country India State Telangana Pincode/Postal Code 505211 Percentage of Mark s/CGPA/Grade Grade of Marks Grade 87 Subjects Mining Engineering Month and Year of P assing 28osir212022, 16:59 Percentage of Mark s/CGPA/Grade Percentage Test City Preferences Preferred Test State 1 MAHARASHTRA Preferred Test City 2 Bilaspur Payment Details Amount 1180 Payment Transactio No. CPACGYONNS Documents Upload Ae Signature Declaration ur. Not.2022 FORM, Marks Obtained 3699 Percentage of Marks 87.04 Preferred Test Nagpur Preferred Test State 3 ODISHA Payment Mode online 08/2017 Maximum Marks 4250, Preferred Test State 2 CHHATTISGARH Preferred Test City 3 Sambalpur Payment Status Payment Success hereby certify that the information given by me in this Application Form ist rue to the best my knowledge. | certify that | fulfill the eligibility criteria and undertake to produce original documents whenever necessary and | will not demand any reschedule of exam. | agree to abide by the declaration of the a uthorities regarding the eligibility of my application and understand that any misrepresentation or omission of facts in my application may justify cancell ation of my Application Form. | understand that all disputes will be subject t © the territorial jurisdiction of Honble High Court of Madhya Pradesh, Jabalp hitps:wow dgiaim com/EForms/SBINewAfterPaymentActon do?798612212582Zoniine 33