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12/8/2015 ESIC::View Page
http://umsesicrectt.in/ViewApplication.aspx 1/2
Application Form UPPER DIVISION CLERK
Personal Details:
Region Applied for:- PUNJAB
Application No:- 4220016917
Photo
Candidate's Name:- NAMDEV
Mother's Name:- KAMBLE SUJATA MAHADEVFather's/Guardian's Name:- KAMBLE MAHADEV KALU
Date Of Birth:- 18/05/1987
Gender:- Male
Category:- SCCitizenship: India
PWD Subcategory: No
Religion: HinduismEx-Serviceman: No
Signature
Govt. Employee: No
ESIC Employee: No
Do You Need Writer(Scribe): NoMarital Status: Un-Married
Other Category, for age relaxation only: No
Mobile Number:- 9689946075Email Address:- [email protected]
Mode of Payment: Exempted
Exam City: 1. Mumbai/Thane/Navi mumbai 2. Pune
Educational Qualification :
Examination Passed Subject/DisciplineName ofBoard/University
Result%MarksYear ofPassing
WhetherthroughDistanceMode(R/C)
Matric/Secondary/10th :marathi hindi englishhostory sceince maths
kolhapur P 49.33 2003 R
Intermediate/Sr.Secondary/12th
:arts pune P 51.17 2005 R
Graduation :
baenglish shivaji P 47.50 2009 R
Any Qualification :
bcacomputer SHIVAJI P 56.17 2014 R
Candidate's Mailing Address :
Correspondence Address:- Permanent Address:-
At-Aurnal Post- DundgegadhinglajkolhapurMaharashtra416501
At-Aurnal Post- DundgegadhinglajkolhapurMaharashtra416501
Helpdesk :[email protected]
12/8/2015 ESIC::View Page
http://umsesicrectt.in/ViewApplication.aspx 2/2
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Declaration:-
I hereby solemnly and s incerely affirm that all the particulars stated by me in this application form are true and correct and I have
verified my eligibility to apply for Recruitment in ESIC .
I have not concealed any information. However, if any information furnished herein by me, is found false, wrong, incorrect or inaccurate,
I understand that my candidature for Recruitment in
ESIC will be cancelled and shall further lead to cancellation of my results/appointment , forfeiture of candidature and even prosecution.
I hereby agree to abide by the rules and regulation
governing the Recruitment process/examination as contained in the Recruitment notice, which I certify to have duly gone carefully and
throughly.
Preview Date: 12/8/2015
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