1. ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR CLERICAL CADRE Please check Print Preview in A4 size Portrait format with 0.25quot;
margin from all sides (Click to Print)38036Registration # :2005154984 Full Name :GUNJAN VERMACategory :GENERAL 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 Children / family members of those who died 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 ? :NOAre you a disabled Ex-Serviceman (DISXS)? :NOAre you a dependent of an Ex-Serviceman killed in action ? :NOHave 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 :NOPassing Out (Indian Navy) Examination conducted by Boys Training Establishment, Visakhapatnam :NOAre 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? :NOAre you seeking relaxation under widow / divorced women / women judicially Separated from their husbands and who are not re-married? :NOWhether Regular Employees of the Union Carbide Factory, Bhopal, retrenched from service (applicable to Madhya Pradesh state only)? :NONationality :INDIANState/ UT which the Centre of Examination Belongs :MaharashtraState / UT Code :30Centre of Examination :MumbaiCentre Code :171Application Fee / Intimation Charges details: Payment Mode:ONLINEOnline Ref ID :MSBI0997798822Amount :350Personal Details : Date of Birth :07-07-1993Age completed as on 01.08.2011 :18Gender :FEMALEHusband's Name/Father's Name :RAJU VERMAMother's Name :HIRESH VERMAAddress for Correspondence :13/104 CHANDRESH ACCORD NEAR SAIBABA MANDIR OPP.SILVERPARKMIRAROAD (EAST)DistrictTHANEState :MAHARASHTRAPin :401107Permanent Address :13/104 CHANDRESH ACCORD NEAR SAIBABA MANDIR OPP.SILVERPARKMIRAROAD (EAST)DistrictTHANEState :MAHARASHTRAPin :401107Contact Details : Email ID :gunjanverma62@yahoo.comPhone No :-Mobile No :9773037386Qualification Details (as on 01.08.2011):Exam PassedSubject /StreamDate of Passing% of MarksSSC/Equivalent :SCIENCE28-06-200880.46HSC/Equivalent :SCIENCE25-05-201069.00Other Details :Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ Ex-Servicemen /PWD) :--If Yes, Centre for Training :--Languages KnownReadWriteSpeakENGLISHYESYESYESHINDIYESYESYESMARATHIYESNOYES 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: 25-09-2011Signature of Applicant Please retain your Registration No. and Password emailed to you carefully for further referenceNOTE: Please DO NOT SEND application printout to IBPS <br />