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rrbs- cwe-iv recruitment of officers scale-i - application form print.pdf

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Registration Number : 1440489330 Full Name : MADHAV SHARAN PANDEY Category : GENERAL Are you a Person with Disability : NO Type of Disability : Percentage of Disability : Are you suffering from cerebral palsy and your writing speed is affected : ? : If Yes, Do you need compensatory time at the time of examination? : Whether your dominant (Writing) hand is affected ? : If Yes,Do you need compensatory time at the time of examination ? : Do you intend to use the services of a scribe(only for VI candidates and the candidates whose writing speed is permanently affected) ? : : Are you a Child/Family Members of those who died in 1984 Riots? : NO Are you a Person domiciled in the State of Jammu & Kashmir during the period from 01.01.80 to 31.12.89.? : NO Religion to which you belong : Hindu Do you belong to Religious Minority Community ? : : NO Are you an ExServiceman : NO Period of service rendered in defence services as an Exserviceman (in months) : Have you joined a Government job on the civil side after availing of the benefits given as an exserviceman? : Have you appeared for the CWE for RRB (RRB CWE I) held in September 2012 ? : NO Post Name : Registration Number : Have you appeared for the CWE for RRB : NO Institute of Banking Personnel Selection CWE for Regional Rural Banks (RRBs CWEIV) Recruitment of Officers ScaleI

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  • 21/07/2015 CWEforRegionalRuralBanks(RRBsCWEIV)RecruitmentofOfficersScaleIApplicationFormPrint

    http://ibps.sifyitest.com/rrbos1jun15/registration_print.php?q=MzUxMzIxOTU5N2NhN2UwMGFiODMzNjk4NjgwOWJhNDl8MTQ0MDQ4OTMzMA== 1/4

    RegistrationNumber : 1440489330

    FullName : MADHAVSHARANPANDEY

    Category : GENERAL

    AreyouaPersonwithDisability : NO

    TypeofDisability :

    PercentageofDisability :

    Areyousufferingfromcerebralpalsyandyourwritingspeedisaffected:?

    :

    IfYes,Doyouneedcompensatorytimeatthetimeofexamination?

    :

    Whetheryourdominant(Writing)handisaffected?

    :

    IfYes,Doyouneedcompensatorytimeatthetimeofexamination?

    :

    Doyouintendtousetheservicesofascribe(onlyforVIcandidatesandthecandidateswhosewritingspeedispermanentlyaffected)?:

    :

    AreyouaChild/FamilyMembersofthosewhodiedin1984Riots?

    : NO

    AreyouaPersondomiciledintheStateofJammu&Kashmirduringtheperiodfrom01.01.80to31.12.89.?

    : NO

    Religiontowhichyoubelong : Hindu

    DoyoubelongtoReligiousMinorityCommunity?:

    : NO

    AreyouanExServiceman : NO

    PeriodofservicerenderedindefenceservicesasanExserviceman(inmonths)

    :

    HaveyoujoinedaGovernmentjobonthecivilsideafteravailingofthebenefitsgivenasanexserviceman?

    :

    HaveyouappearedfortheCWEforRRB(RRBCWEI)heldinSeptember2012?

    : NO

    PostName :

    RegistrationNumber :

    HaveyouappearedfortheCWEforRRB : NO

    InstituteofBankingPersonnelSelectionCWEforRegionalRuralBanks(RRBsCWEIV)RecruitmentofOfficersScaleI

  • 21/07/2015 CWEforRegionalRuralBanks(RRBsCWEIV)RecruitmentofOfficersScaleIApplicationFormPrint

    http://ibps.sifyitest.com/rrbos1jun15/registration_print.php?q=MzUxMzIxOTU5N2NhN2UwMGFiODMzNjk4NjgwOWJhNDl8MTQ0MDQ4OTMzMA== 2/4

    (RRBCWEII)heldinSeptember/October2013?

    PostName :

    RegistrationNumber :

    HaveyouappearedfortheCWEforRRB(RRBCWEIII)heldinSeptember2014?

    : NO

    PostName :

    RegistrationNumber :

    AadhaarCardNo. :

    Nationality/Citizenship: : Indian

    Doyouhaveanyworkexperience? : NO

    IfYes,Mentiontheworkexperience :

    State/UT(towhichcentreofexambelongs)

    : UttarPradesh

    CentreofExamination : Meerut

    ApplicationFee/Intimationcharges:

    PaymentIn : ONLINE

    Amount : 600.00

    PaymentStatus : PAID

    ReferenceID : DSBI3917691560

    TransactionDate : 21072015

    PersonalDetails

    DateofBirth : 08081989

    Agecompletedason01.07.2015 : 25

    Gender : MALE

    MaritalStatus : Unmarried

    Father'sName : RAMHARIPANDEY

    Mother'sName : ASHADEVI

    Spouse'sName :

    AddressforCorrespondence : 27778FIRSTFLOOR

    : NEARSINGHSABHAGURUDWARA

    : DAKKAJOHAR

    District : DELHI

    State : DELHI

    Pincode : 110009

    PermanentAddress : RAMHARIPANDEY

    : KHAIWALIGALICHAUTHAIMOHALLA

    : HOLIROADBALDEO

  • 21/07/2015 CWEforRegionalRuralBanks(RRBsCWEIV)RecruitmentofOfficersScaleIApplicationFormPrint

    http://ibps.sifyitest.com/rrbos1jun15/registration_print.php?q=MzUxMzIxOTU5N2NhN2UwMGFiODMzNjk4NjgwOWJhNDl8MTQ0MDQ4OTMzMA== 3/4

    District : MATHURA

    State : UTTARPRADESH

    Pincode : 281301

    ContactDetails

    MobileNo : +918471074810

    AlternativeNumberMobileNo/LandlineNo.

    : +917065885011

    EmailID : [email protected]

    EducationalandProfessionalQualificationDetails(ason28.07.2015)

    ExamPassed Degree/Subject/Stream

    DateofPassing

    %ofMarks Class/Grade

    Graduation/Equivalent OthersBTech 01072012 65.40 FirstClass

    DoyouhaveComputerKnowledge?

    : YES

    Ifyes,DetailsofComputerKnowledge

    : BASICANDHTML

    LanguageinorderofProficiency

    1Hindi2English

    BankinorderofPreference

    1SarvaUPGraminBank2UttarBiharGraminBank3GraminBankofAryavart4PrathamaBank5AllahabadUPGraminBank6BarodaUPGraminBank7SarvaHaryanaGraminBank8KashiGomtiSamyutGraminBank9MadhyanchalGraminBank10CentralMadhyaPradeshGraminBank11HimachalPradeshGraminBank12UttarakhandGraminBank13MadhyaBiharGraminBank14RajasthanMarudharaGraminBank15PurvanchalBank16BiharGraminBank17BarodaRajasthanKshetriyaGraminBank18VananchalGraminBank19NarmadaJhabuaGraminBank20ChhattisgarhRajyaGraminBank21ArunachalPradeshRuralBank22JharkhandGraminBank23NagalandRuralBank24EllaquaiDehatiBank

  • 21/07/2015 CWEforRegionalRuralBanks(RRBsCWEIV)RecruitmentofOfficersScaleIApplicationFormPrint

    http://ibps.sifyitest.com/rrbos1jun15/registration_print.php?q=MzUxMzIxOTU5N2NhN2UwMGFiODMzNjk4NjgwOWJhNDl8MTQ0MDQ4OTMzMA== 4/4

    OtherDetails

    AreyoudesirousoftakingPreExamTraining(ApplicableOnlyforSC/ST/MinorityCommunity):

    :

    IfYes,CentreforTraining :

    Declarationforallthecandidates(OtherthanVIandOC)

    IherebydeclarethatallthestatementsmadeinthisapplicationareTrue,CompleteandCorrecttothebestofmyknowledgeandbelief.IunderstandthatintheeventofanyinformationbeingfounduntrueorincorrectatanystageorIamnotsatisfyinganyoftheeligibilitycriteriastipulated,andalsoincaseofcreatinginfluence/unduepressureregardingrecruitmentshalltantamounttocancellationofmycandidature.

    Date:21072015 SignatureofApplicant


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