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ON-LINE APPLICATION FOR RECRUITMENT OF CLERICAL CADRE

Last Modified On: 28-12-2011 No Of Times Modified: 2

1603

Registration # : 3000000265

Full Name :Sarvaiya Yashesh

Jagrutbhai

State/UT Applied for : Gujarat

Category : OBC

If Person with Disability : NO

Type of Disability : -

Percentage of Disability : -

Do you intend to use the services of a scribe (only for VI & OH candidates whose writing

speed is affected by cerebral palsy) ? :NA

Are you candidate who had o rdinarily been domiciled in Kashmir Division of the Stateof J & K during the period 1-1-1980 to 31-12-1989 ? :

NO

Whether you belong to Religious Minority Community ? : NO

Religion to which you belong : -

Are you an Ex-Serviceman ? : NO

Are you Disabled Ex-Serviceman (DISXS) ? : NO

Are you a Matriculate ? :

Have you obtained the Indian Army Special Certificate of Education

or corresponding certificate in the Navy or the Air Force, after having

completed not less than 15 years of service in Armed Forces of the Union :

Are you Dependent of an Ex-Serviceman killed in action (DXS)? : NO

Are you seeking relaxation under widow /divorced women / women

judicially Separated from their husbands and who are not re-married ? :

NO

Nationality / Citizenship : India

Centre of Examination : Bhavnagar

Centre Code : 12

Application Fee / Intimation Charges details:

Payment Mode: CBS

Amount : 350.00

Personal Details :

Date of Birth : 27-12-1989

Age completed as on 01.12.2011 : 21

Gender : MALE

Husband's Name/Father's Name : Sarvaiya Jagrutbhai MaganlalMother's Name : Sarvaiya Rekhaben Jagrutbhai

Address for Correspondence : B-12 Shantinath Appartment

Near Golibar Temple

Rupani Circle

District Bhavnagar

State : GUJARAT

Pin : 364001

Permanent Address : B-12 Shantinath Appartment

Near Golibar Temple

Rupani Circle

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District Bhavnagar

State : GUJARAT

Pin : 364001

Contact Details :

Email ID : y.sarvaiya9904@gmail.com

Phone No : 0278-2562682

Mobile No : 9426149904

Qualification Details (as on 01.12.2011):

Exam Passed Subject /Stream Date of Passing % of Marks

SSC/Equivalent : Gujarati 10-03-2005 77.71

HSC/ 12th(10+2) / Equivalent : Commerce 12-03-2007 60.86

Graduation/Equivalent : Management 16-04-2010 75.43

Other : CCA computer 09-01-2010 92.75

Other Details :

Would You like to undergo Pre-Exam Training (SC/ST/Minority Community/ XS /

DXS / Dependents of XS) :--

If Yes Centre for Training : --

Languages Known Read Write Speak

English YES YES YES

Hindi YES YES YES

Gujarati YES YES YES

DECLARATION:

I hereby dec lare 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 incorrec t at any stage or my not satisfying any of the eligibility cr iteria according to the Central Rec ruitment & Promotion Department, my candidature is liable to cancelled. I

am willing to serve anywhere in India including rural areas.

Place:

Date: 28-12-2011 Signature of Applican

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application printout to IBPS

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