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Are you an Employee of Central Government or Employees' Provident Fund Organization ? : NO Quota : If physically Challenged : Type of Disability : Category of Disablement : Percentage of disability : Do you intend to use the services of a scribe? : Are you an Ex - Serviceman ? : Period of Service as an Ex-Serviceman (in months) : Nationality : Name of Region : Examination Centre : Centre code : Application Fee / Postal Charges Details : Payment IN : Journal No : Branch Name : Branch Code number : Deposit Date : Amount : Personal Details : Date of Birth : Age completed(as on 09.03.2012) : Gender : Father's Name / Husband's Name : Mother's name : Address for Correspondence : 03-06-1989 22 MALE D MAHABOOB VALLI D RASOOL BEE #3-10-215 YS JAYAMMA COLONY BAKARAPURAM PULIVENDULA District : State : Pin : Permanent Address : YSR ANDHRA PRADESH 516390 #3-10-215 YS JAYAMMA COLONY BAKARAPURAM PULIVENDULA District : State : YSR ANDHRA PRADESH State Bank of India 013986284 srinagar colony kurnool 12719 29-02-2012 315 None NO NA NO -indian Tamil Nadu Chennai 35
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Pin : 516390
Contact Details: Email ID : Phone No : Mobile No: Qualification Details (as on 09.03.2012): Exam Passed Graduation/Equivalent : Working Knowledge of Computers : Details of Computer Knowledge : Post Qualification Work experience details (Start from present Employer) : Name of the Employer Designation From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Reason for Leaving Length of Service (YY/MM) Name of the Course/Degree BSc MPC Year of Passing 02-09-2009 YES MSOFFICE % of Marks 71.00 Class / Grade Pass Class baba143.d@gmail.com 9492516517
DECLARATION:
I hereby declare that i. I declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications etc, prescribed for admission to the examination for the quota / category under which I have applied. ii. All the statements made in this application are true , correct and complete to the best of my knowledge and belief, and if any of the particulars furnished by me are found to be incorrect or suppressed, or my ineligibility being detected before or after the examination, my candidature is liable to be rejected at any stage of the selection process. Even if it is found after my appointment in EPFO that the particulars furnished by me were incorrect , false, incomplete or suppressed, my services would be liable to be terminated without any notice. iii. I also declare that I do not stand debarred by any organisation under the Government of India as on date and have never been convicted by any court of law. I also declare that no charge sheet is pending against me in any court of law. Further declare that I have never been dismissed or removed from Govt Service or my service been terminated during probation. iv. I agree that my final appointment shall be subject to my fulfilling all the conditions / eligibility criteria as per rules applicable for the category / quota under which I have applied. v. For Candidate belonging to Ex-Serviceman I declare that I fulfill all the eligibility conditions relating to EX-Serviceman as per rules existing in this regard. vi. For candidates belonging to Sports Quota I declare that I fulfill all the eligibility conditions relating to recruitment of meritorious Sports persons as per advertisement / rules existing in this regard. vii. In case of my selection I am willing to serve anywhere in India.
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