Application Form

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LIFE INSURANCE CORPORATION OF INDIA
CENTRAL OFFICE, "YOGAKSHEMA", JEEVAN BIMA MARG, MUMBAI 400 021 Recruitment for the Post of ASSISTANT ADMINISTRATIVE OFFICER (Generalists / Chartered Accountants / Company Secretary/ Legal)

Unique Application Registration Number :
Post Applied Post Code Category
(GENERAL/ OBC/SC/ST) GENERAL

101017553
Nationality Gender
Age as on 01/11/2010
YEAR MONTH DAYS

DOB
(DD/MM/YYYY) 20/09/1988

ASSISTANT ADMINISTRATIVE OFFICER(GENERALISTS)

101

INDIAN

MALE

22

1

12

1 . Candidate Name 2 . Father's/Husband's Name 3 . Mother's Name

S NARAYANAN N.SUBRAMANIAN M.LALITHAMBAL

4. Choice of Examination City :
Name of City City Code

5. Sub-Category
PH Please write : Yes/No, if ECO/SSRCO required Scribe LIC Employee

VH

OH

No COIMBATORE 08 No No

No

6. Are you a member of Institute of Chartered Accountants of India ?
Are you a member of ICAI Membership No. Membership Date

No 7. Are you a member of Institute of Company Secretaries of India ?
Are you a member of ICSI Membership No. Membership Date

No 8. Candidate Address
Name Father/Husband Address

:

S NARAYANAN

: N.SUBRAMANIAN :
NO.3 FIRST STREET M.K.P.COLONY GANAPATHY PO

SPACE FOR PHOTOGRAPH

District State

: :

COIMBATORE TAMIL NADU

Pin Code Tel. No. Email ID.

:

641006

Contact Details STD Mobile No.

0422

2535454 [email protected]
Signature of Candidate

9442334835

9. Details of Fee :
LIC Branch Code A/C Code No. Transaction Date Transaction No. Miscellaneous Collection Amount (Rs.)

91C 10. Educational Qualification

114033

27/11/2010

87360

2226

400

Name of Examination 12th

Name of Examination Passed MATHS PHYSICS CHEMISTRY

Name of University / Institute BOARD OF HIGHER SECONDARY EDUCATION TAMILNADU ANNA UNIVERSITY CHENNAI

Year of Passing % age of marks 2005 80.2

Graduation

B.E (MECHANICAL)

2009

67.0

Post Graduation

Professional

Other Examination

11. Post Qualification Experience :

*********************************************************************************************** DECLARATION
I hereby declare that all statements made in this application are true and correct to the best of my knowledge and belief. I understand that in the 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.

Place : Date :
Signature of the Applicant

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