BEL India 2012_ Online Application for PE_PO

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/05/2012 BEL India 2012: Online Application For PE/PO

ecialtest.in/bel2012/user/[email protected]&RegNo=437021

BEL : PROBATIONARY ENGINEERS(PE) - 2012Applicatio n Form

*

App lica t ion No . : 437021

*App lic at ion f or the Po st of : PR OBA TIONA RY ENGINEERS(PE ) - Elect ro nics

Personal Particulars

*Name (as it appea rs in yourSSLC/SSC certificate)

Mr. KAPADIA NAITIKBHAIDIPAKKUMAR

*Add re ss f or Communica t ion BA DELA LA KKA DPITHA

B/H ARAVIND SAW MILL

PATHTHARGATE

* City /Distr ict VADODARA * Pin Code 390001

* State GUJARAT

* Contact No. with STD Code 265 -2411355 Mobile No 9974283990

* Ne are st R a ilwa y St at ion VA DO DA RA * Nat ionality INDIAN

* Gender MALE

* Date of Birth 22-Feb-1987

* Religion HINDU

* E-mail ID nait ikkapadia@gmail. com A lternate E-mail ID, if any nait ik_kapadia@yahoo. com

Qualifications Details

* Engineering Degree B. E.

* Inst itut ion GUJARAT UNIVERSITY

* Engineer ing Degree Status Passed * Month & Ye ar of P as sing Jun -2009

* Branch Electronics *

Percentage / Class in

Engineering Degree 62.50 /First

Employment Deta ils

*Are you Employed? YES

If Yes, Type ofOrganisation

OTHER Name of the Or ganisationBABARIA INSTITUTE OFTECHNOLOGY

Designat ion ASS. PROFFESOR Pay Sca le (CTC for others) 180000

General Information


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* Category OBC

*Are you a Domicile of J&KDuring 1.1.1980 t o31.12.1998?

NO

*Are you a Pe rs on withDisabilities (PWD)?

NOIf Yes,Indicate type ofdisability andPercentage of disability

%

*Are you an Ex -Se rv iceman? NO Se rv ice in De fence 0 Years 0 Mont hs

If Yes, Indicate branch of

Armed for ces and da te ofdischarge(DD/MM/YYYY)

Writt en Test Detail

* Writ ten test center MumbaiLanguage in which youwant to take the test

English

Challan Details (if not exempted)

* Journal No. 028605373 * Challan Date 2-May-2012

* Challan A mount 500 * S BI Ba nk Br an ch Na me JAYRATNA BUI LDI NG

Declaration

I hereby declare that I have verif ied the details indicated above a nd also confirm that all theinformation submitted is correct to the best of my knowledge. At any stage, if i t is found thatany of the above information is incorrect and/or is suppressed, the management of BEL shallhave the r ight to take action, as deemed f it.

App lic at ion No . 4370 21

Place

Date Signature of Applicant

(To be signed prior to despat ch)

Kindly save this page by using 'SAVE AS' option given in the browser before taking the printout.

Print

(Please Print the f orm for Further R eference)

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Important Instruction for Candidates:

1. Attach y our passport size photograph (without attestation) in the space provided below.2. Endorse your signatures in the space provided below.3. Application Form receive d without two photographs, signatures at two places and Original Bank

Challan (Company Copy) of Rs.500/- will be rejected.4. Send the duly completed A pplication form along with Original Challan (Company Copy) hav ing

Journal No. given by Bank at the f ollowing address on or bef ore 16 May 2012:Post Box No.3076,

Lodi Road,New Delhi-110003.

5. Do NOT send any c opy of the cert ificate a longwith the duly completed application form. Originalcertificates of the short listed candidates will be scrutinized / verified at the time of interview.

Applicatio n No.: 437 02 1

Name: KAPADIA NAITIKBHAI DIPAKKUMARAdd ress: BA DELA LA KKA DPITHAB/H ARAVIND SAW MILLPATHTHARGATE

VA DODA RA -3 90001GUJARAT

Test Date: 01 July 2012 (Sunday)

Signature of Applicant(in the space provided)


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Please Cut & Affix the Address Label given below on the envelop for sending print version of Online Application Formalong with Original Challan (Company C opy) hav ing Journal No. given by Bank at the following address on or bef ore 1

May 2012:

------------------------------------- --------------------------

BEL-2012: Application for the Post of

PROBATIONARY ENGINEERS(PE)

Discipline: Electronics

To

POST BOX NO. 3076 ,

LODI ROAD,

NEW DELHI-110003.

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BEL India 2012_ Online Application for PE_PO

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