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RECRUITMENTOFADMINISTRATIVEOFFICERS(GENERALISTS)(SCALEI)ApplicationFormPrint
TheNewIndiaAssuranceCompanyLtd.[NIA]
RECRUITMENTOFADMINISTRATIVEOFFICERS(GENERALISTS)(SCALEI)
RegistrationNumber
: 116113187
FullName
: MadhanC
Category
: OBC
IfPersonwithDisability
: NO
TypeofDisability
Percentageofdisability
Areyousufferingfromcerebralpalsyandyourwritingspeedisaffected
IfYes,Doyouneedcompensatorytimeatthetimeofexamination?
Whetheryourdominant(Writing)handisaffected
IfYes,Doyouneedcompensatorytimeatthetimeofexamination?
Doyouintendtousetheservicesofascribe(onlyforVI&OC
candidatesandthecandidateswhosewritingspeedispermanently
affected)?
WhetherordinarilydomiciledintheStateofJammu&Kashmirduring
theperiod1180to311289?
: NO
AreyouExistingConfirmedEmployeeofPublicSectorGeneral
InsuranceCompanies(includingGIC&AgricultureInsuranceCompany
ofIndiaLtd.)
: NO
AreyouanExServiceman:?
: NO
AreyouaDisabledExServiceman(DISXS)?
: NO
PeriodofService(inMonths)
HaveyoujoinedaGovernmentjobonthecivilsideafteravailingofthe
benefitsgivenasanexserviceman?
Religiontowhichyoubelong
: Hindu
WhetheryoubelongtoReligiousMinorityCommunity
: NO
DoyouholdAadharCard?
: NO
AadharCardNo.
Nationality
: Indian
State/UTwhichthecentreofPhaseIExaminationbelongs
: Tamilnadu
CentreofPhaseIExamination
: Vellore
ApplicationFee/IntimationChargesDetails
Amount
: 600.00
PaymentStatus
: PAID
ReferenceID
: HHMP4849200879
TransactionDate
: 23102016
PersonalDetails
DateofBirth
: 24121991
Agecompletedason01.10.2016
: 24
Gender
: MALE
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RECRUITMENTOFADMINISTRATIVEOFFICERS(GENERALISTS)(SCALEI)ApplicationFormPrint
MaritalStatus
: Unmarried
Father'sNameinFull
: Vschinnusamy
Mother'sNameinFull
: vceswari
Spouse'sName
AddressforCorrespondence
: sevenvatakalvalasarstreet
Address2
: vengiampalayam
Address3
: pasur
District
: Erode
State
: TAMILNADU
Pincode
: 638154
Permanentaddress
: sevenvatakalvalasarstreet
Address2
: vengiampalayam
Address3
: pasur
District
: Erode
State
: TAMILNADU
Pincode
: 638154
ContactDetails
MobileNo
: +919940953954
AlternativeNumber
(MobileNo/LandlineNo)
EmailID
: madhanvc8@gmail.com
EducationalQualificationDetails(ason01.10.2016)
ExamPassed
Degree/Subject/Stream
Dateof
Passing
%ofMarks
Class/Grade
Graduation
OthersBECSE
21042013
70.10
FirstClass
Doyouhaveoperating/workingknowledgeof : YES
computers
Detailsofcomputerknowledge
: DEGREEINCOMPUTERSCIENCE
Workexperiencedetails(StartfrompresentEmployer)
Nameofthe
Employer
Designationand
Rankifany
BOI
CLERK
TotalPeriodofService
From
To
02/07/2014 01/08/2016
Yearsof
Service
(YY/MM/DD)
Natureofduties
performed
IndustryType
Reasonfor
Leaving
2/1/0
CLERICAL
BANK
TOHAVEA
CAREERA
TNIACL
TotalRelevantExperience(inmonths):25
OtherDetails:
LanguagesKnown
Read
Write
Speak
ENGLISH
YES
YES
YES
TAMIL
YES
YES
YES
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RECRUITMENTOFADMINISTRATIVEOFFICERS(GENERALISTS)(SCALEI)ApplicationFormPrint
Declaration:
IherebydeclarethatallthestatementsmadeinthisapplicationareTrue,CompleteandCorrecttothebestofmyknowledgeandbelief.I
understandthatintheeventofanyinformationbeingfounduntrueorincorrectatanystageorIamnotsatisfyinganyoftheeligibility
criteriastipulated,andalsoincaseofcreatinginfluence/unduepressureregardingrecruitmentshalltantamounttocancellationofmy
candidature.
Date:23102016
SignatureofApplicant
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