CONTESTANT APPLICATION FORM

First Name: _BENOY_________________ Middle Name________________ Last

Name__JACOB________________

Age as on 1st October 2009 ____29_________ Gender (M / F):_________M_________________________

Address: ___ MANGALAMATTOM HOUSE

KADAMAKUZHY P.O.

VALLAKKADAVU

KATTAPPANA SOUTH PO

PIN: 685515

City: __IDUKKI_______________________________ State: ____KERALA

Contact number (M) 9447065845 (R)_04868-251720__(O)_04868-273584

Language Spoken: _Malayalam /Hindi /Tamil /English/Gujarathi

E-mail:benoy@live.in

1) What levels of education have you completed (please specify school and major):
High School, Some College, Professional Degree, Bachelors Degree, Masters Degree, Doctorate.
Higher Secondary

Diploma in Computer Application

_____________________________________________________

2) Who is your current employer and occupation? (What job pays your bills now?)

Shinewell Offset Press, Kattappana

Graphic Designer cum DTP Operator

3) Please list your last three jobs:

A:___Computer Hardware Engineer_____ B: Instructor in Computer (IT) in Vadodara, Gujarat

C: Graphic Designer cum DTP Operator

4) Please circle those that apply: Married, Separated, Boyfriend / Girlfriend, Single, Engaged

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How long have you been in your current relationship? Married, 27-04-2009

5) What would your friends say are your best qualities?

Good Personality

6) What would your friends say are your worst qualities?

Over Confidence
7) What is your unique and personal motivation for wanting to be on the show?

To Participate DEAL OR NO DEAL and make experience & money

8) What is the next milestone in your life if you do not make it to the Show?

To settle well and To build a house

9) Describe your most embarrassing moment:

When I was in Gujarath, I was the victim of Earth Quake. So many people died. At the
time of earth quake, I was taking bath in the morning. That time I was afraid.

10) What is the weirdest / unique thing about you?

1. I can rotate both hands opposite direction in both ways.

2. I can lift up my collarbone and eyebrow separately.

11) What is your idea of a dream vacation?: ____________________________________________________

________________________________________________________________________________________

12) What makes you a great contestant for ‘Deal or No Deal’ (“Show”)?

________________________________________________________________________________________

________________________________________________________________________________________

13) Besides the Show, what game show would you be the best contestant for and why?

________________________________________________________________________________________

14) List all TV game/talk/reality shows/contests which have already aired or which may air
within the next
year, on which you have appeared, and whether or not you won any prizes. If you have NOT
appeared on
any such shows, please state this. Do not leave the space below blank.

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 Show Name Air Date Amount Won

15) Below please list the people you would like to appear with you on the show to help support
you:

Supporter #1:

Name : __BIJU JACOB____________________________________________________________

Telephonel # : __9946548001,
9447232154______________________________________________

Supporter’s relationship to you :__Elder Brother____________________________________

Why do you want this Supporter with you on stage? _____He’ll guide
me_______________________

Supporter #2:

Name : __LIVEA BENOY__________________________________________________________

Telephone # : _9496300584________________________________________________________

Supporter’s relationship to you:____________Wife__________________________________________

Why do you want this Supporter with you on stage? _________She’ll be always with me for
any time

Supporter #3:

Name : __BIBIN JACOB__________________________________________________________

Telephone # :
_9846017686_____________________________________________________________

Supporter’s relationship to you:_____Younger

Brother______________________________________________________

Why do you want this Supporter with you on stage?

__________________________________________

Please list any additional supporters you may wish to appear with you on camera
(along with the same
information asked above) on the back of this page.

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16) Have you ever been charged/accused with any crimes? _____No_______________________

17) If YES, please describe in detail, tell us when and where the event occurred, and what the
outcome was including FIR/Case
numbers:______________________________________________________________

18) Have you ever been convicted in any crimes? _______________No__________________________

19) If YES, please describe in detail, tell us when and where the event occurred, and what was
the sentence /
punishment:__________________________________________________________________________

20) Is there any pending litigation against you? _______No__________. If YES, please describe
when and where

the event(s) occurred, the other party (ies) to the lawsuit(s), whether you were the plaintiff
or defendant,

the nature of the case(s), and what the outcome was for each
case_______________________________

21) Is there anyone among your family, friends, or work colleagues that would object to your
appearing on

television? (NO) (Circle One). If YES, please identify all such persons, including your
relationship

with them and the reason they would

object.________________________________________________

Please read, sign and date the following acknowledgement:

I warrant and represent that I am above 18 years of age.

I agree and accept that in the event of any death or injury or bodily harm caused to me at the
time of auditions/ shooting of any episode of the Show/ Program, Endemol India Private
Limited and Sun TV Network Limited shall not be responsible for the same.

I agree that the selection will be at the sole discretion of Endemol India Private Limited and
Sun TV Network Limited and it is understood by me that the rules are subject to changes
without any notification.

I hereby acknowledge that: (i) I have read the Terms and Conditions attached herewith and
agree to be bound by the same and the eligibility requirements; (ii) I have answered the
previous questions honestly, completely and accurately; (iii) if any of the above information is

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found to be false or incomplete, this will be grounds for dismissal from the selection process for
the Show, and/or from the Show itself, if selected. Further Endemol India Private Limited and
SUN Network Limited reserve the right to change/ modify the terms any time without any prior
intimation.

Name: Benoy Jacob Signature:

Date: 06-10-2010

Place: Kattappana

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