3/29/2021 Applications for the posts of Assistant General Manager (General Administration / Technical / Accounts / Law) and Medical

s / Law) and Medical Officer

Food Corporation of India 310140

Applications for the posts of Assistant General Manager (General Administration / Technical / Accounts / Law) and Medical
Officer

Registration Number : 1980203890

Full Name : DEEPAK RANJAN DASH

Post: : Assistant General Manager (General Administration)

Post Code: : A
Category : EWS
Are you a person with benchmark disability of 40% and above ? : NO
Disability category : -
Type of Disability : -
Do you need compensatory time at the time of examination ? : -

Are you suffering from cerebral palsy and your writing speed is : -
affected ?
If Yes, Do you need compensatory time at the time of : -
examination?
Whether your dominant (Writing) hand is affected ? : -
If Yes, Do you need compensatory time at the time of : -
examination?
Do you intend to use the services of a scribe ? : -

Whether scribe will be brought by candidate ? : -

Do you need scribe from FCI? : -
Do you fall under the category of Ex-Servicemen / Emergency : NO
Commissioned Officer or SSC Officer ?
If yes, select the category : : -
Period of Service (in months) : -

Have you joined a Government job on the civil side after availing : -
of the benefits given as an ex-serviceman?

Are you Departmental (FCI) employee ? : NO

Whether you possess the requisite supporting document for : YES
claim of reservation/relaxation as per the advertisement ?

Document No. : Date of Issue of the document : Document Issuing Authority :

092020 31-01-2020 tahasildar bhapur

In reference DoPT OM No. 39020/01/2016 Estt.(B) dated : NO

21.12.2020, 21.06.2016 and 9.07.2017, whether the candidate
agrees to disclose his personal details including scores &
rankings obtained in recruitment examination to NCS portal
(www.ncs.gov.in) ) of Ministry of Labour & Employment ?
Do you belong to Religious Minority Community ? : NO

Religion to which you belong : -

Nationality / Citizenship : Indian

State/UT of Examination Centre : ODISHA

Centre of Examination : BHUBANESHWAR

Application Fee / Intimation charges

Payment In : ONLINE

Fees : 847.46

https://ibpsonline.ibps.in/fcivpcpfeb21/registration_print.php?q=NTFlZmMzZTNhOWM3M2Q5ZDgxYzRkNWFmMmM5NDNjYzB8MTk4MDIwMzg5MA== 1/3
3/29/2021 Applications for the posts of Assistant General Manager (General Administration / Technical / Accounts / Law) and Medical Officer
Tax : 152.54 (IGST)

Amount : 1000.00
Payment Status : PAID

Reference ID : VSM29868505211
Transaction Date : 29-03-2021

Personal Details
Date of Birth : 05-06-1991

Age completed as on 01.01.2021 : 29

Gender : MALE

Do you have twin brother / sister ? : NO

Name of the twin : : -

Gender of the twin : : -

Marital Status : Unmarried

Father's Name : DASARATHI DASH

Mother's Name : SATYABHAMA DASH

Spouse's Name : -

Address for Correspondence

Address 1 : ATPO FATEGARH

Address 2 : PS FATEGARH DIST NAYAGARH

Address 3 : VIA BHAPUR

District : BBSR

State : ORISSA
Pincode : 752063

Permanent address

Address 1 : ATPO FATEGARH

Address 2 : PS FATEGARH DIST NAYAGARH

Address 3 : VIA BHAPUR

District : BBSR

State : ORISSA

Pincode : 752063

State for GST invoicing : Permanent Address (ORISSA)

Contact Details

Mobile No : +91 7008082277

Alternative Number : +91 9556360114

(Mobile No/Landline No)
Email ID : deepakdash935@gmail.com

Educational Qualification (as on 01.01.2021)

Exam Passed Degree/ Subject / Stream Date of Passing % of Marks Class / Grade

Graduation/Equivalent from a recognized LAW 06-09-2020 68.77 First Class

University/Institutes

Other Details :

Languages Known Read Write Speak

English YES YES YES

Hindi YES YES YES

Oriya YES YES YES

https://ibpsonline.ibps.in/fcivpcpfeb21/registration_print.php?q=NTFlZmMzZTNhOWM3M2Q5ZDgxYzRkNWFmMmM5NDNjYzB8MTk4MDIwMzg5MA== 2/3
3/29/2021 Applications for the posts of Assistant General Manager (General Administration / Technical / Accounts / Law) and Medical Officer

Uploaded Document Details :

1. Left thumb impression

2. Hand written declaration

Declaration:

I hereby declare that all the 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 I am not satisfying any of the eligibility criteria stipulated, and also in case of creating influence/undue pressure regarding recruitment shall
tantamount to cancellation of my candidature.

Date: 28-03-2021 Signature of Applicant

Left thumb impression

Hand written declaration

https://ibpsonline.ibps.in/fcivpcpfeb21/registration_print.php?q=NTFlZmMzZTNhOWM3M2Q5ZDgxYzRkNWFmMmM5NDNjYzB8MTk4MDIwMzg5MA== 3/3