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ON-LINE APPLICATION FOR COMMON WRITTEN EXAM FOR SPECIALIST OFFICERS

23035
Registration # : Full Name : Post : Post Code : Category : If Person with Disability : 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) ? : Whether you Children / family members of those who died in 1984 riots? : Whether you domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? : Are you an Employee of any participating Bank ? : Name of the Participating Bank : Employee Number : Are you an Ex-Serviceman ? Nationality / Citizenship : State/ UT which the Centre of Examination Belongs : State / UT Code : Centre of Examination : Centre Code : Application Fee / Intimation Charges details: Payment Mode: Online Ref ID : Amount : Personal Details : Date of Birth : Age completed as on 01.12.2011 : Gender : Husband's Name/Father's Name : Mother's Name : Address for Correspondence : 12-08-1986 25 MALE Ram Dulare Ram Pyari Devi Gate No 23 Main Lane Bhakti Nagar Lalpur Cantt District State : Pin : Permanent Address : Varanasi UTTAR PRADESH 221002 Gate No 23 Main Lane Bhakti Nagar Lalpur Cantt District State : Pin : Varanasi UTTAR PRADESH 221002 ONLINE MCTR2672119778 50 3000211844 Arun Kumar Sagarwa l Technical Officer (Scale I) 05 SC NO NA NO NO NO --NO Indian Uttar Pradesh 43 Lucknow 143

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Contact Details : Email ID : Phone No : Mobile No : Qualification Details (as on 01.12.2011): Exam Passed Graduation: Degree B.Tech Subject /Stream Date of Passing Civil 30-06-2010 % of Marks 68.36 Class / Grade First Class arunsagarwal1@rediffmail.com 8960183906

As on date for Post Qualification Work Experience should be 01.12.2011 Name of the Employer & Nature of Employment Total Experience (in months) : Languages Known Hindi English Read YES YES Write YES YES Speak YES YES Designation and Rank if any From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Remark(Reason for Leaving) Years of Service (YY/MM)

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: 14-01-2012 Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application printout to IBPS