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Application Registration No: 64004627307 for the Multi Tasking(Non - Technical) Staff In Different States/ UTs, 2016
Your Application is not Completed
1.& 1.1. Name of Center and Center Code : WR-Mumbai(7204)
WR-Thane(7210)
WR-Alibaug(7216)
2.Candidate Name : AKASH
3.Father's Name : VILAS
4.Mother's Name : PRATIBHA
5.Date of Birth (dd/mm/yyyy) : 06/06/1996
6. Age(as on 01.08.2017) : 21.2
7. Nationality : Indian
8.Gender : Male
9.Category : OBC
10. Whether PH (PWD) : No
10. If yes, indicate code :
10.1. Whether Ex-Serviceman? : No
10.2. For Ex-Serviceman-Length of Service(in years) :
10.2. Date of discharge (dd/mm/yyyy) :
11. Whether seeking Age relaxation? : No
11.1. If yes, indicate code :
12. Whether suffering from cerebral palsy? :
12. If VH/Cerebal Palsy candidate, whether scribe is required ?
13. if yes indicate medium :
14. Whether you belong to Religious Minority Community ? : Yes
15. Aadhar Card Number (If available): 831660474421
16.Mark of Visible Identification :
17. State/UT Code : 2XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
18. Educational Qualification : 12th Pass
19. Details of Work Experience :
Period of Period of
Name of the organisation Designation Nature of Duty(ies) Service Service
From(mm/yyyy) To(mm/yyyy)
96 JAFFAR BABA CO-OP HOUSING SOCIETY
20.Postal Address :
MOUNT MARY ROAD BANDRA WEST MUMBAI-50
Village/City : MUMBAI
District : ANDHERI
State : Maharashtra
Pincode : 400050
96 JAFFAR BABA CO-OP HOUSING SOCIETY
21.Permanent/Domicile Address :
MOUNT MARY ROAD BANDRA WEST MUMBAI-50
State : Maharashtra
Pincode : 400050
STD Code :
Phone Number :
Mobile Number : 8655461808
Email ID : dhumala10@gmail.com
22.Photo 23.Signature

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Payment Details :
Transaction id :
Transaction Date(yyyy-mm-dd) :
Amount :
Declaration
I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and
belief. I understand that in the event of any information being found suppressed false or incorrect or ineligibility being detected
before and after examination, my candidature/appointment is liable to be cancelled.
Place:
Date (yyyy-mm-dd):
Signature of Candidate

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