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ON-LINE APPLICATION FOR RECRUITMENT OF APPRENTICE DEVELOPMENT OFFICERS-2012-13

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Registration # : 1322681

Full Name :

HITESH PRAJAPAT

Category : Type of Applicant : Are you an Ex-Serviceman ? : Zone : Zone Code : Choice of Division : Division Code : Choice of Examination Centre : Centre Code : Applied For : Nationality : Personal Details : Date of Birth : Age completed as on 01.11.2012 : Gender : Husband's Name: Father's Name : Mother's Name : Correspondence Address : Address for Correspondence :

OBC Others NO Northern Zone 01 AJMER 101 JAIPUR 105 Rural Indian

05-01-1988 24 MALE

BHANWAR LAL PRAJAPAT MANJU DEVI PRAJAPAT

HITESH PRAJAPAT S-O BHANWAR LAL PRAJAPAT BEHIND RAILWAY MALGODOWN WARD NO-40 SUJANGARH

District State : Pin Code : Permanent Address :

CHURU RAJASTHAN 331507 HITESH PRAJAPAT S-O BHANWAR LAL PRAJAPAT BEHIND RAILWAY MALGODOWN WARD NO-40 SUJANGARH

District State :

CHURU RAJASTHAN

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Pin Code : Contact Details : Phone NO: Mobile No : Email ID : Qualification Details : Exam Passed Graduation / Equivalent (as on 01.11.2012): Master Degree / Post Graduate Diploma in Marketing Work Experience : Salary Roll(SR) No : Designation : Office : Date of Appointment : Date of Confirmation : Period Of Service after Confirmation in Months : Have you completed 3 years of service after confirmation in Class III post Agency Code No : Date of Appointment : Branch Office : Business Performance Details : Sr No Agency Year Net First Year's Premium No of Lives Subject / Stream science University/Board rajasthan university Year of Passing 30/06/2009 % of Marks 55.48 Class / Grade Second Class +919785409405 prajapath@gmail.com 331507

MBA Marketing

MDS University Ajmer

05/10/2012

61.42

First Class

Have you completed not less than 5 years as an agent and has brought a net First Years Premium Income of not less than Rs. 5,00,000/- during the immediately preceding 5 agency years and a net First Year Premium Income of not less than Rs. 1,00,000/- on 50 lives in each of any 3 of these agency years? Have you completed not less than 4 years as an agent and has brought a net First Years Premium Income of not less than Rs. 1,00,000/- on 50 lives per year in any 3 of the immediately preceding 4 agency years? If Related to any Agent/Employee/Officer/Medical Examiner etc. LIC of India Please State : His / Her Name : Designation : Place of Posting / Working : Exact Relationship : Languages Known English Hindi Rajasthani Details of Pre-Exam Training Would you like to undergo Pre-examinationTraining:(Only for SC/ST) Read YES YES YES Write YES YES YES Speak YES YES YES

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Place:

Date: 21-12-2012 Declaration

Signature of Applicant

I hereby declare that all statement made in this application are true and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect or not satisfying the prescribed eligibility criteria for the post applied for ,my candidature is liable to be cancelled/rejected at any stage of selection.

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