Recruitment of Assistant in United India Insurance Company Limited [UIICL] - Application Form Print
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Registration Number : 500038242 Full Name : VENNELAKANTI PAVAN KUMAR State/UT for Exam : : Andhra Pradesh Examination Centres : Gondlavelleru Category : UR 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 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 B /LV and the candidates whose writing speed is permanently affected)? : Whether Persons domiciled in Jammu & Kashmir during the period from 01.01.1980 to 31.12.1989 : NO Religion to which you belong : Hindu Whether you belong to Religious Minority Community ? : NO Do you have the Knowledge of Regional Language of the State : YES Are you an ExServiceman : NO Are you a Disabled ExServiceman (DISXS) ? : If Yes, Date of Discharge: : Actual service rendered in defence services which may be counted for qualifying as an Exserviceman (In Months) : Are you dependant of Serviceman killed in action (DXS)?: : NO Are you Displaced persons from East Pakistan who have migrated to India on or after 01.01.1964 : NO Are you Existing Employees of United India Insurance Co. Ltd? : NO If Yes, Employee No. : Designation : Place of Work : Are you Resident of Assam State during the period from 01.01.1980 to 15.08.1985 ? : NO Aadhar Card No. : 900544389787 United India Insurance Company Limited [UIICL] Recruitment of Assistant
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Transcript of Recruitment of Assistant in United India Insurance Company Limited [UIICL] - Application Form Print
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7/8/2015 RecruitmentofAssistantinUnitedIndiaInsuranceCompanyLimited[UIICL]ApplicationFormPrint
http://ibps.sifyitest.com/uiiclasjul15/registration_print.php?q=NzdjYTNhMjJjOGI1ZjM5NjE3NmExMWNiYzk1YzhkNGZ8NTAwMDM4MjQy 1/3
RegistrationNumber : 500038242
FullName : VENNELAKANTIPAVANKUMAR
State/UTforExam: : AndhraPradesh
ExaminationCentres : Gondlavelleru
Category : UR
AreyouaPersonwithDisability : NO
TypeofDisability :
PercentageofDisability :
Areyousufferingfromcerebralpalsyandyourwritingspeedisaffected?
:
IfYes,Doyouneedcompensatorytimeatthetimeofexamination?
:
Whetheryourdominant(Writing)handaffected? :
IfYes,Doyouneedcompensatorytimeatthetimeofexamination?
:
Doyouintendtousetheservicesofascribe(onlyforB/LVandthecandidateswhosewritingspeedispermanentlyaffected)?
:
WhetherPersonsdomiciledinJammu&Kashmirduringtheperiodfrom01.01.1980to31.12.1989
: NO
Religiontowhichyoubelong : Hindu
WhetheryoubelongtoReligiousMinorityCommunity? : NO
DoyouhavetheKnowledgeofRegionalLanguageoftheState : YES
AreyouanExServiceman : NO
AreyouaDisabledExServiceman(DISXS)? :
IfYes,DateofDischarge: :
ActualservicerenderedindefenceserviceswhichmaybecountedforqualifyingasanExserviceman(InMonths)
:
AreyoudependantofServicemankilledinaction(DXS)?: : NO
AreyouDisplacedpersonsfromEastPakistanwhohavemigratedtoIndiaonorafter01.01.1964
: NO
AreyouExistingEmployeesofUnitedIndiaInsuranceCo.Ltd? : NO
IfYes,EmployeeNo. :
Designation :
PlaceofWork :
AreyouResidentofAssamStateduringtheperiodfrom01.01.1980to15.08.1985?
: NO
AadharCardNo. : 900544389787
UnitedIndiaInsuranceCompanyLimited[UIICL]RecruitmentofAssistant
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7/8/2015 RecruitmentofAssistantinUnitedIndiaInsuranceCompanyLimited[UIICL]ApplicationFormPrint
http://ibps.sifyitest.com/uiiclasjul15/registration_print.php?q=NzdjYTNhMjJjOGI1ZjM5NjE3NmExMWNiYzk1YzhkNGZ8NTAwMDM4MjQy 2/3
Nationality: : Indian
ApplicationFeeDetails:
PaymentIn : ONLINE
Amount : 450.00
PaymentStatus : PAID
ReferenceID : DSBI3892040465
TransactionDate : 08072015
PersonalDetails
DateofBirth : 02011990
Agecompletedason30.06.2015 : 25
Gender : MALE
MaritalStatus : Unmarried
Father'sName : Vrajasekhar
Mother'sName : vbalatripurasundari
Spouse'sNameinFull :
AddressforCorrespondence : DNO27271
: KOJJILLIPET
: MACHILIPATNAM
District : KRISHNA
State : ANDHRAPRADESH
Pincode : 521001
PermanentAddress : DNO27271
: KOJJILLIPET
: MACHILIPATNAM
District : KRISHNA
State : ANDHRAPRADESH
Pincode : 521001
ContactDetails
PhoneNo :
MobileNo : +919581971732
EmailID : [email protected]
QualificationDetails(ason30.06.2015)
ExamPassed Subject/Stream DateofPassing
%ofMarks Class/Grade
HSC/Equivalent MPC 31032007 87.80 FirstClass
Graduation/Equivalent Science 31032013 80.11 FirstClass
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7/8/2015 RecruitmentofAssistantinUnitedIndiaInsuranceCompanyLimited[UIICL]ApplicationFormPrint
http://ibps.sifyitest.com/uiiclasjul15/registration_print.php?q=NzdjYTNhMjJjOGI1ZjM5NjE3NmExMWNiYzk1YzhkNGZ8NTAwMDM4MjQy 3/3
LanguagesKnown Read Write Speak
English YES YES YES
Hindi YES YES NO
TELUGU YES YES YES
LanguageDetails:
DECLARATION
IherebydeclarethatallthestatementsmadeinthisapplicationareTrue,CompleteandCorrecttothebestofmyknowledgeandbelief.IunderstandthatintheeventofanyinformationbeingfounduntrueorincorrectatanystageorIamnotsatisfyinganyoftheeligibilitycriteriastipulated,andalsoincaseofcreatinginfluence/unduepressureregardingrecruitmentshalltantamounttocancellationofmycandidature.
Date:08072015 SignatureofApplicant
