INSTITUTE OF BANKING PERSONNEL SELECTION Ing et hd in IBPS ii eA een} a a ut Common Recruitment Process (CRP) for Recruitment of Probationary Officers / Management Trainees in Participating Banks (CRP PO/MT-XIII) Registration Number 2280833199 Full Name KHUSBU HELA Category : SC ‘Are you a person with benchmark disabilly of 40% |: NO and above ? ‘Type of Disability Pe Sub-Type of Disabilty for ID & Others! Pe ‘Sub-Type of Disability . ‘Sub-Type of Multiple Disability - ‘Are you as per PWBD guidelines eligible to use - ‘compensatory time at the time of examination ? ‘Are you suffering from cerebral palsy and your - writing speed is affected : 7 IY¥es, Do you need compensatory time at the time: = ‘of examination? Whether your dominant (Writing) hand is affected? : IYes, Do you need compensatory time at the time: = ‘of examination? ‘Are you eligible to use the services of scrbe as per Government guidelines & do you wish to use the services of scribe ? ‘Are you a person with specified disabilly covered: NO Under the definition of sec 2(5) of the RPWD Act, 2016 and not covered under sec 2(0) ofthe said act ‘and having difficulty in wring? IfYes, Do you need compensatory time at the time =~ ‘of examination? ‘Are you a person with specified disabilty covered: - Under the definition of sec 2(s) of the RPwD Act, 2016 and having dificult in writing and not covered Under sec 2(?) of the said act and eligible to use the services of Scribe and wish to avail the services of Scribe?| certy that, I will upload (in current application) the certificate from competent medical authority of a Government healthcare institution as per Ministry of ‘Social Justice and Empowerment, Department of Empowerment of Persons with Disabilities (Divyangian) OM No. F No. 29-6/2018-DD-II dated 110.08,2022. ‘Are you a child! family member of those who died in 1984 riots 7 ‘Are you an Ex-Serviceman : ? ‘Actual service rendered in defence services which may be counted for qualifying as an Ex-serviceman (In Months) Date of relief from defence services Have you joined a Government job on the civil side after avaling of the benefits given as an ex- serviceman ? Religion to which you belong Do you belong to Religious Minority Community ? Whether serving in Govt. quasi Govt / Public Sector Undertakings (including Nationalised Banks & Financial Institutions) ? Have you appeared for the CWEICRP-POIMT earlier ? How many attempts ? Select the CWE/CRP-POIMT attempted easlior Nationality / Citizenship State/UTINCR to which centre of examination belongs State code Centre of Preliminary Examination Centre of Main Examination intend to bring the following ID when appearing for the examination (confirm my name on this 1D and this application exactly match) ID Proof ID Proof No, Application Fee / Intimation charges Payment In Fees Tax ‘Amount Payment Status Reference ID Transaction Date 2 NO 1 NO. : Hindu No 1 NO. NO Indian West Bengal 248 Greater Kolkata + Greater Kolkata : YES Aaghaar Card 2 XXXXXXKX2200 ONLINE 148.30 26.70 IGST) 175.00 PAID : YHD42056200463 26-08-2028Personal Details Date of Bith ‘Age completed as on 01.08.2023 Gender ‘Aadhaar Card Number PAN Card Number Do you have twin brother / sister ? Gender of the twin Name of the twin Marital Status Father's Name Mother's Name Spouse's Name ‘Address for Correspondence Address 1 Address 2 Address 3 Distict State Pincode Permanent address ‘Address 1 Address 2 Address 3 Distict State Pincode State for GST invoicing Contact Details Mobile No Alternative Number (Mobile No/Landline No) Email ID + 16-08-1998 224 2 FEMALE 2 XXXXXXXX2200 2 OOKKK224E 2 NO + Unmarried RAJKUMAR HELA : ANJUHELA : TALBANDA HEMANT NAGAR 1 POST OFFICE JUGBERIA 2 700110 + NORTH 24 PARGANA 2 WEST BENGAL + 700110 : TALBANDAHEMANT NAGAR, + POST OFFICE JUGBERIA 2 700110 + NORTH 24 PARGANA 1 WEST BENGAL + 700110 : Permanent Address. (WEST BENGAL) +91 7980802979 2 +01 8961126408 + Khusbuhela16@gmall.com Educational Qualification (as on 21.08.2023)Exam Passed Degree Subject /Stream Date of ——% of Marks. Class / Grade Passing Graduation / Bsc Science 30-12-2020 57.00 ‘Second Class Equivalent Do you have Operating and working yes knowledge in computer systems Details of Computer Knowledge: Certificate in ‘Computer Operations Work experience details (Start from present Employer) Name of the Designation Total Perlod of Service Nature of Duties. Reasonof Years of. Employer Frem Te leaving Experience (yvimmipD) Presently : YES working? KHUSBUHELA BACK OFFICE 01! yei082023 1-RESPONSIBLE 276 BACK OF owowzo21 26iosi2023 1 RE Vv TRAINING TEAM ME ‘otal Experience in months : 34 Banks Preference 4 Central Bank of India 2 Canara Bank 3 Bank of India 4 Punjab National Bank 5 Punjab & Sind Bank banks in order of Preferences 6 Indian Bank 7 Indian Overseas Bank BUCO Bank ‘9 Union Bank of India 10 Bank of Baroda 11 Bank of Maharashtra Other Details : For the safety and well being of candidates, : YES Pre-Exam Training may not be held. In case it is possible to hold Pre-Exam Training, are you desirous of taking Pre-Exam Training ? (Applicable only for SC/ST/ OBCIMinority Community): Yes {Centre for Training 2 Kolkata ‘Whether any prosecution /detention /fine/ —: NO. conviction / sentence against you has been awarded by any court of law for any offence? Ityes, particulars of the same -HINDI ves yes Yes ENGLISH Yes Yes Yes BENGALI No No Yes Uploaded Document Details : 1. Left Thumb Impression 2. Hand Written Declaration Declaration: I hereby declare that, [have read, understood and agreed the terms and conditions of the Advertisement for the said post and all the statements made in the application are True, Complete and Correct to the best of my knowledge and belief. | understood that in the event of any information being found untrue or incorrect at any stage or | am not satisfying any of the eligibilty criteria stipulated, and also in case of creating influence’ undue pressure regarding recruitment shall tantamount to cancellation of my candidature | wil follow all the Guidelines regarding Social Distancing Mode of Exam given in advertisement and subsequently. Any Violation may result in cancellation of my candidature | confirm that my name as filed by me in the application form exactly matches with the name in my ID proof rons Hedy Date: 26-08-2023 Left Thumb ImpressionHand Written Declaration