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EXECUTIVE TRAINEE RECRUITMENT 2011

APPLICATION CONFIRMATION FORM CONTAINING IMPORTANT PARTICULARS AS FILLED IN THE ON LINE APPLICATION SYSTEM BY THE CANDIDATE

Candidate Name: PANKAJ UPADHYAY Post Applied with Discipline: Executive Trainee - Mechanical Application Registration Number: GAET022106 Test City (Preference 1): Lucknow Test City (Preference 2): Delhi Date of Birth: 20/08/1988 Category: GEN Physically Challenged: No Date of Demand Draft: 01/09/2011

ESSENTIAL QUALIFICATION:
Bachelor Degree: BTech

Subjects/Branch: Mechanical Percentage of marks: 68.65 Year of Passing: 2010 Mode: Full Time Demand Draft Number: 335587 Demand Draft Bank Details: Bank of Baroda

CHECKLIST (Please confirm by indicating tick mark against the relevant points)
1. Affixed 2 Passport Colour Photographs Please affix your latest passport size colour photograph (please do not sign on the photograph) 2. Put Left Hand Thumb Impression 3. 02 Signatures (01 Specimen and 01 after declaration) 4. Attached Demand Draft for Rs.200/ (for General and OBC candidate

Only)
5. Written Application Registration Number, Name and DisciplineonbackoftheDD(for General and OBC candidate Only) 6. Attached attested true copy of SC/ST Caste Certificate (for SC/ST

candidateOnly)
7. Attached PH Certificate (for PH Candidate only)
Pl. put your left hand thumb impression in blue/black ink within box without touching the borders

Please affix your latest passport size colour photograph (please do not sign on the photograph)

Please put your Signature within the box without touching the borders (Not in Capital letters)

Declaration: I do hereby declare that particulars/information given in the Application Confirmation Form are true and correct to the best of my knowledge and belief. If any, information given herein is found to be fraudulent, incorrect or untrue, my candidature for the post applied is liable to be rejected and cancelled at any stage during/after the selection process.

Place: Date:
Signature of the candidate (Not in Capital letters)

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