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This online application is provisional subject to payment of application fees/ intimation charges

36027
Registration # : 1110616884

Full Name :

S SHAIKSHAVALI

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 candidates whose writing speed is affected by cerebral palsy)? : Whether Children/Family Members of those who died in 1984 Riots? : Whether domiciled in Kashmir Division of the State of Jammu & Kashmir during the period 1-1-1980 to 31-12-1989? : Do you belong to a Religious Minority Community? : Religion to which you belong : Are you an Ex-Serviceman? : Are you a Disabled Ex-Serviceman (DISXS)? : Are you a Dependent of an Ex-Serviceman (DXS)? : Are you a matriculate Ex-Servicemen candidate, who has obtained the Army Special Certificate of Education or corresponding certificate in the Navy or Air Force after having completed not less than 15 years of service in the Armed Forces of the Union? : Percentage of Marks : Are you seeking relaxation under window / divorced women / women judicially separated from their husbands and who are not re-married? : Whether Regular Employees of the Union Carbide Factory, Bhopal, retrenched from service (applicable to Madhya Pradesh state only)? : Have you applied for the CWE for Clerical Cadre held in November/ December 2011? Note: If Yes, Please enter your Registration Number Registration Number: Nationality / Citizenship : State/ UT which the Centre of Examination Belongs : State / UT code : Centre of Examination : Centre code : Application Fee / Intimation Charges : Payment through : Amount : Personal Details : Date of Birth : Age completed as on 01.10.2012 : Gender : Husband's Name : Father's Name : Mother's Name : Address for Correspondence :

GENERAL NO NA NO NO YES Muslim NO NO NO

NA

NO NO

NO

Indian Muslim Karnataka 26 Bengaluru 152

OFFLINE 400.00

10-06-1991 21 MALE

S USMAN S JAINABEE H.NO.49-1A-84 2ND FLOOR

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JNR NAGAR KURNOOL District State : Pin code : Permanent Address : KURNOOL ANDHRA PRADESH 518002 H.NO.49-1A-84 2ND FLOOR JNR NAGAR KURNOOL District State : Pin code : Contact Details : Phone No : Mobile No : Email ID : Educational Qualification (as on 01.10.2012) : Exam Passed Graduation / Equivalent : Knowledge of Computers : Details of Computer Knowledge : Subject /Stream ECE Date of Passing 18-05-2012 YES Studied Computer/IT as a Subject in High School/College/Institute % of Marks 61.83 Class / Grade First Class 9505193708 syedforall@gmail.com KURNOOL ANDHRA PRADESH 518002

Do you have work experience? : Total Experience in months (as on 01.10.2012) : Other Details : Would you like to undergo Pre-Exam Training (SC/ST/Minority Community/ExServicemen/PWD)? : If Yes, Centre for Training : Languages Known English Hindi Telugu Read YES YES YES

NO

NO -Write YES YES YES Speak 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: 27-10-2012

Signature of Applicant

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

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