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                       Recruitment of Administrative Officer (Scale-I)



                                                                                                                                                                     19029
                                                                                                                                        Please paste your recent
                                                                                                                                        passport size photograph
                                                                                                                                        and sign across it. Please
                                                                                                                                        retain atleast 5 copies of
                                                                                                                                        same photograph with you
                                                                                                                                        for subsequent use.


Registration # :                                                                                                  1011727

Full Name :                                                                                                       Raib Das
Group:                                                                                                            Group J Generalist

Code No. :                                                                                                        10

Category :                                                                                                        SC

If physically challenged :                                                                                        NO

Type of Disability :                                                                                              -

Percentage of Disability :                                                                                        -

Do you wish to use the services of a scribe
                                                                                                                    NA
(in case a Written Examination is held, only for VH candidates whose writing speed is affected by cerebral palsy)?:
Are you an Emergency Commissioned Officers (ECO) & Short Service & Retrenched Commissioned Officers
                                                                                                                  NO
(SSCRO)? :
Period of Service (in months) :                                                                                   --

Whether you persons who have ordinarily been domiciled in Kashmir Division of J&K State during the period
                                                                                                                  NO
01.01.1980 to 31.12.1989 ? :
Are you Resident of Assam State during the period from 01.01.1980 to 15.08.1985 ? :                               YES

Are you a confirmed employees of General Insurance Corporation of India, Public Sector General Insurance
                                                                                                                  NO
Companies, Tariff Advisory Committee & AICIL?:
Nationality :                                                                                                     Indian

Centre of Examination :                                                                                           Guwahati

Centre code :                                                                                                     18

Application Fee / Postal Charges Details :
Payment In:                                                                                                       Axis Bank

Transaction ID/Journal No :                                                                                       M175995

Branch Name :                                                                                                     Fancy bazar

Branch Code Number :                                                                                              608
                                                                                                                  18-05-
Date of Remittance : (24.04.2012 - 31.05.2012)
                                                                                                                  2012
Amount :                                                                                                          100



Personal Details :
Date of Birth :                                                                                                   18-01-1990

Age completed as on 01.04.2012:                                                                                   22
Gender :                                                                                                          MALE

Marital Status :                                                                                                  Single
Husband�s Name / Father�s Name :                                                                                  Sunil chandra das

Mother's name :                                                                                                   Kalpana das
Address for Correspondence :                                                                                      C/o-sunil Ch Das

                                                                                                                  Add-goshaion Colony
                                                                                                                  N-area W/no-2
                                                                                                                  Lanka Nagaon Assam
District :                                                                                                        Nagaon

State :                                                                                                           ASSAM
2/2
 Pin code :                                                                                                                         782446

 Permanent Address :                                                                                                                C/o-sunil Ch Das

                                                                                                                                    Add-goshaion Colony
                                                                                                                                    N-area W/no-2
                                                                                                                                    Lanka Nagaon Assam

 District :                                                                                                                         Nagaon

 State :                                                                                                                            ASSAM

 Pin code :                                                                                                                         782446

 Contact Details :
 Phone No. :                                                                                                                        03674-256403

 Mobile No. :                                                                                                                       9401878921

 Email ID :                                                                                                                         rajibdas777@gmail.com

 Educational and Professional Qualification Details(as on 01.04.2012):

                Exam Passed                 Name of the               Name of Institute/          Month and      % of Marks        Class/Grade
                                           Subject/Stream             College/ University          Year of
                                                                                                   Passing
                  Graduation :                 Science                         LCB                 08/2011           70.75          First Class

 Have you passed at least 3 papers of the examination conducted by Actuarial Society of India?:                                     NO

 Working Knowledge of Computers :                                                                                                   YES

                                                                                                                                    MS office Ms word tally
 Details of Computer Knowledge :
                                                                                                                                    pc repairin

Post Qualification work experience details (Start from present Employer) :

    Name of the Employer &               Designation and Rank            From(mm/yyyy)           To(mm/yyyy)          Nature of duties performed              Reason for Leaving           Year of Service
     Nature of Employment                                                                                                                                                                      (YY/MM)

 Total Relevent Experience (in months) :                       -


                                                                       Languages Known               Read           Write         Speak

                                                                              English                 YES           YES            YES

                                                                              Bengali                 YES           YES            YES

                                                                            Assamese                  YES           YES            YES



DECLARATION:
              I hereby confirm and declare that all the statements made and information provided by me in this Application are true, correct and complete to the best of my knowledge and belief. In the event
of any information or the part of it being found false or incorrect before or after the recruitment process, action can be taken against me by the competent authority and my candidature/appointment will
automatically be cancelled/ terminated.




Place:

Date: 23-05-2012                                                                                                                                                                      Signature of Applicant



                                                                                                                                                                                                       Raib Das

                                     Please retain your Registration No. and Password emailed to you carefully for further reference
                                     NOTE: Please DO NOT SEND application print-out to the Bank

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Administrative Officer Recruitment

  • 1. 1/2 Recruitment of Administrative Officer (Scale-I) 19029 Please paste your recent passport size photograph and sign across it. Please retain atleast 5 copies of same photograph with you for subsequent use. Registration # : 1011727 Full Name : Raib Das Group: Group J Generalist Code No. : 10 Category : SC If physically challenged : NO Type of Disability : - Percentage of Disability : - Do you wish to use the services of a scribe NA (in case a Written Examination is held, only for VH candidates whose writing speed is affected by cerebral palsy)?: Are you an Emergency Commissioned Officers (ECO) & Short Service & Retrenched Commissioned Officers NO (SSCRO)? : Period of Service (in months) : -- Whether you persons who have ordinarily been domiciled in Kashmir Division of J&K State during the period NO 01.01.1980 to 31.12.1989 ? : Are you Resident of Assam State during the period from 01.01.1980 to 15.08.1985 ? : YES Are you a confirmed employees of General Insurance Corporation of India, Public Sector General Insurance NO Companies, Tariff Advisory Committee & AICIL?: Nationality : Indian Centre of Examination : Guwahati Centre code : 18 Application Fee / Postal Charges Details : Payment In: Axis Bank Transaction ID/Journal No : M175995 Branch Name : Fancy bazar Branch Code Number : 608 18-05- Date of Remittance : (24.04.2012 - 31.05.2012) 2012 Amount : 100 Personal Details : Date of Birth : 18-01-1990 Age completed as on 01.04.2012: 22 Gender : MALE Marital Status : Single Husband�s Name / Father�s Name : Sunil chandra das Mother's name : Kalpana das Address for Correspondence : C/o-sunil Ch Das Add-goshaion Colony N-area W/no-2 Lanka Nagaon Assam District : Nagaon State : ASSAM
  • 2. 2/2 Pin code : 782446 Permanent Address : C/o-sunil Ch Das Add-goshaion Colony N-area W/no-2 Lanka Nagaon Assam District : Nagaon State : ASSAM Pin code : 782446 Contact Details : Phone No. : 03674-256403 Mobile No. : 9401878921 Email ID : rajibdas777@gmail.com Educational and Professional Qualification Details(as on 01.04.2012): Exam Passed Name of the Name of Institute/ Month and % of Marks Class/Grade Subject/Stream College/ University Year of Passing Graduation : Science LCB 08/2011 70.75 First Class Have you passed at least 3 papers of the examination conducted by Actuarial Society of India?: NO Working Knowledge of Computers : YES MS office Ms word tally Details of Computer Knowledge : pc repairin Post Qualification work experience details (Start from present Employer) : Name of the Employer & Designation and Rank From(mm/yyyy) To(mm/yyyy) Nature of duties performed Reason for Leaving Year of Service Nature of Employment (YY/MM) Total Relevent Experience (in months) : - Languages Known Read Write Speak English YES YES YES Bengali YES YES YES Assamese YES YES YES DECLARATION: I hereby confirm and declare that all the statements made and information provided by me in this Application are true, correct and complete to the best of my knowledge and belief. In the event of any information or the part of it being found false or incorrect before or after the recruitment process, action can be taken against me by the competent authority and my candidature/appointment will automatically be cancelled/ terminated. Place: Date: 23-05-2012 Signature of Applicant Raib Das Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank