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Registration Slip

Intelligence Bureau
Ministry of Home Affairs, Govt. of India Registration Slip
Post Applied For : Personal Information: Applicant's First Name: Applicant's Middle Name: Applicant's Last Name: Father's /Mother's First Name: Father's /Mother's Last Name: Relationship: Gender: Date Of Birth: Are you a Central Govt. Employee with 3 or more years of Continuous Service? : SADHU PROHALLAD SADHU FATHER MALE 5/3/1987 NO PROTIK ACIO GRADE-II/EXECUTIVE
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Category: Religion: Nationality: State of Domicile: Are you an Ex-Serviceman? If Yes, Please fill in the details :

GENERAL HINDU INDIAN WEST BENGAL NO

Years/Months/Days

Domicile of J&K during the period 01.01.1980 to NO 31.12.1989 : Qualification Details: Name of Graduation Degree: Branch/Name of the Course: Month & year of Passing: Duration of the Course: Division/Class of Passing: Enter Marks (as awarded by University) and
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B.SC BIO TECHNOLOGY Month: JULY Year: 2007 Years: 3 Months: 0 FIRST

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Registration Slip

Maximum Marks: College/Institute Name Name of Affiliated University Additional Qualification (if any) :

Marks Scored: 1106 Out of Maximum: 1800 %age: 61.44 SRM INSTITUTE OF SCIENCE AND TECHNOLOGY SRM UNIVERSITY YES Name of Qualification POST GRADUATION : Details : COMPUTER APPLICATION

Additional Information: Contact No. (Only Digits): Alternate Mobile No. (if any): Email ID: Alternate Email ID (optional): Choice of Examination Center: Test Centre: Address for all Future Correspondence: Address Line 1: Address Line 2: Address Line 3: City/Town: PIN: State: Home State to which candidate belong to: Declaration/Confirmation: Are you prepared to serve anywhere in India? YES 7.G.T.ROAD BIRHATA BURDWAN BURDWAN 713101 WEST BENGAL WEST BENGAL KOLKATA +919233687631 +91 protikrocky@gmail.com protikrocky@gmail.com

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