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11/6/2016

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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11/6/2016

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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11/6/2016

RECRUITMENTOFADMINISTRATIVEOFFICERS(GENERALISTS)(SCALEI)ApplicationFormPrint

Declaration:
IherebydeclarethatallthestatementsmadeinthisapplicationareTrue,CompleteandCorrecttothebestofmyknowledgeandbelief.I
understandthatintheeventofanyinformationbeingfounduntrueorincorrectatanystageorIamnotsatisfyinganyoftheeligibility
criteriastipulated,andalsoincaseofcreatinginfluence/unduepressureregardingrecruitmentshalltantamounttocancellationofmy
candidature.

Date:23102016

SignatureofApplicant

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