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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR CLERICAL CADRE

3203

Registration # : 2005189232

Full Name : RAJAMOHAN R

Category : SC

If Person with Disability : NO

Type of Disability : -

Percentage of Disability : -

Do you intend to use the services of a scribe

(only for VI & OC both hands affected by cerebral palsy) ? :NA

Whether you Chi ldren / fami ly members of those who d ied in 1984 riots? : NO

Whether you domiciled in Kashmir Division of the State of

J&K during the period 1-1-1980 to 31-12-1989? :NO

Whether you belong to Religious Minority Community ? : NO

Religion to which you belong : -

Are you an Ex-Serviceman ? : NO

Are you a disabled Ex-Serviceman (DISXS)? : NO

Are you a dependent of an Ex-Serviceman killed in action ? : NO

Have you passed in one of the following Armed Forces Examinations equivalent to

Civil Examination of HSc/Pre-University? :

IAF Education Test for Promotion to rank of Corporal : NO

Passing Out (Indian Navy) Examination conducted by Boys Training Establishment,

Visakhapatnam :NO

Are you a matriculate Ex-Servicemen candidate, who has obtained the Indian Army

Special Certificate of Education or corresponding Certificate in the Navy or the Air

Force after having completed not less than 15 years of service in Armed Forces of the

Union? :

NO

Are you seeking relaxation under widow / divorced women / women judicially

Separated from their husbands and who are no t re-married? :NO

Whether Regular Employees of the Union Carbide Factory, Bhopal, retrenched from

service (applicable to Madhya Pradesh state only)? :NO

Nationality : INDIAN

State/ UT which the Centre of Examination Belongs : Tamilnadu

State / UT Code : 41

Centre of Examination : Thiruchirapalli

Centre Code : 203

Application Fee / Intimation Charges details:

Payment Mode: CBS

Name Of Payee Bank : Indian Overseas Bank

Transaction No. : C0045230911C0029

Branch Name : KUTHALAM

DP Code / Branch Code No : 045

Deposit Date : 23-09-2011

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Amount : 50

Personal Details :

Date of Birth : 21-06-1985

Age completed as on 01.08.2011 : 26

Gender : MALE

Husband's Name/Father's Name : RAMAKRISHNAN N

Mother's Name : RANI R

Address for Correspondence : 36 SONANTHIDAL

KUTHALAM

District NAGAPATTINAM

State : TAMILNADU

Pin : 609801

Permanent Address : 36 SONANTHIDAL

KUTHALAM

District NAGAPATTINAM

State : TAMILNADU

Pin : 609801

Contact Details :

Email ID : nrsraj21@yahoo.com

Phone No : -Mobile No : 9688184796

Qualification Details (as on 01.08.2011):

Exam Passed Subject /Stream Date of Passing % of Marks

SSC/Equivalent : STATE BOARD 31-03-2001 53.00

HSC/Equivalent : STATISTICS 31-03-2004 48.00

Graduation/Equivalent : BA CO OPERATION 31-03-2007 50.00

Post Graduation/Equivalent : MCOM CO OP MGT 31-03-2009 62.00

Other Details :

Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ Ex-

Servicemen /PWD) :YES

If Yes, Centre for Training : Thiruchirapalli

Languages Known Read Write Speak

TAMIL YES YES YES

ENGLISH YES YES YES

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: 25-09-2011 Signature of Applican

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application printout to IBPS

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