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ON-LINE APPLICATION FOR RECRUITMENT OF APPRENTICE DEVELOPMENT OFFICERS-2012-13

0035

Registration # : 1253281

Full Name : Mohit Krishna

Category : GENERAL

Type of Applicant : Others

Are you an Ex-Serviceman ? : NO

Zone : Northern Zone

Zone Code : 01

Choice of Division : NEW DELHI-I/II/III

Division Code : 110

Choice of Examination Centre : NEW DELHI

Centre Code : 110

Applied For : Urban

Nationality : Indian

Personal Details :

Date of Birth : 25-02-1988

Age completed as on 01.11.2012 : 24

Gender : MALE

Husband's Name:

Father's Name : Mr. Birendra Kumar Singh

Mother's Name : Mrs. Usha Singh

Correspondence Address :

Address for Correspondence : Room No. 205

Sapphire Hostel

Indian School Of Mines

District Dhanbad

State : JHARKHAND

Pin Code : 826001

Permanent Address : Room No. 205

Sapphire Hostel

Indian School Of Mines

District Dhanbad

State : JHARKHAND

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Exam Passed Subject /

Stream

University/Board Year of Passing % of Marks Class / Grade

Graduation /

Equivalent (as on

01.11.2012):

BTech in ITUttrakhand Technical

University30/06/2010 59.74 Second Class

Sr No Agency Year Net First Year's

Premium

No of Lives

Pin Code : 826001

Contact Details :

Phone NO: -

Mobile No : +917677087433

Email ID : mohit_kps@rediffmail.com

Qualification Details :

Work Experience:

Salary Roll(SR) No :

Designation :

Office :

Date of Appointment :

Date of Confirmation :

Period Of Service after Confirmation in Months :

Have you completed 3 years of service after confirmation in Class III post

Agency Code No :

Date of Appointment :

Branch Office :

Business Performance Details :

Have you completed not less than 5 years as an agent and has brought a net First Years

Premium Income of not less than Rs. 5,00,000/- during the immediately preceding 5 agency

years and a net First Year Premium Income of not less than Rs. 1,00,000/- on 50 lives ineach of any 3 of these agency years?

Have you completed not less than 4 years as an agent and has brought a net First Years

Premium Income of not less than Rs. 1,00,000/- on 50 lives per year in any 3 of the

immediately preceding 4 agency years?

If Related to any Agent/Employee/Officer/Medical Examiner etc. LIC of India Please State :

His / Her Name :

Designation :

Place of Posting / Working :

Exact Relationship :

Languages Known Read Write Speak

English YES YES YES

Hindi YES YES YES

Details of Pre-Exam Training

Would you like to undergo Pre-examinationTraining:(Only for SC/ST)

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Place:

Date: 18-12-2012 Signature of Applicant

Declaration

I hereby declare that all statement made in this application are true and correct to the best of my knowledge and belief. I understand that inthe event of any information being found false or incorrect or not satisfying the prescribed eligibility criteria for the post applied for ,my

candidature is liable to be cancelled/rejected at any stage of selection.

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application printout to IBPS

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