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Application Form UPPER DIVISION CLERK

Personal Details:

Region Applied for:- PUNJAB

Application No:- 4220016917

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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

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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]

mailto:[email protected]

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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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