ETME153231: Nuclear Power Corporation of India Limited (A Government of India Enterprise)

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NUCLEAR POWER CORPORATION OF INDIA LIMITED

(A GOVERNMENT OF INDIA ENTERPRISE)

APPLICATION FORM ET-2016

SPECIMEN SIGNATURE
REGISTRATION NO
1._____________________________________
ETME153231
2._____________________________________

1. DISCIPLINE APPLIED FOR : Mechanical

2. NAME : Mr.SAIRAM BALAMURUGAN M

3. DATE OF BIRTH : 11-01-1993 (23 years,4 months,6 days)

4. FATHER'S NAME : MADASAMY G

5. MOTHER'S NAME : MALLIKA M

1
6 .GENDER : Male

7 .NATIONALITY : Indian

23
8 .MARITAL STATUS : Single

9. RELIGION : HINDU

10 .MOTHER TONGUE : TAMIL

11. CATEGORY : SC
53
12. MOBILE NO : 8903326863

13. EMAIL ID : saikarthikeyan93@gmail.com

14. STATE/UT OF DOMICILE : TAMIL NADU


E1

D-20 ANUVIJAY TOWNSHIP (POST), RADHAPURAM TALUK,


15. ADDRESS FOR CORRESPONDENCE :
TIRUNELVELI, TAMIL NADU-627120, INDIA 04637-267990

16. NEAREST RAILWAY STATION : KANNIYAKUMARI

17.Are you a dependent of those who died in the riots of 1984(Dep 1984)? : No

18.Are you physically domiciled in Kashmir division of Jammu Kashmir state from 01/01/1980 to 31/12/1989? : No
M

19.Whether you are a dependent of defence perssonel killed in action(DODPKIA)? : No

20.Are you physically disabled? : No


ET

21.Educational Qualification:
Are you appearing for your final year exam in April/May/June 2016? : No

Year of
Type Degree Discipline College/Institute Board/University Year of passing Aggregate(%)
Enrollment

BTech KALASALINGAM KALASALINGAM


UG Mechanical 2011 2015 68.9
FullTimeCourse UNIVERSITY UNIVERSITY

Any Other Information

Application Fee Status : EXEMPTED

UNDERTAKING

I declare that the particulars given in the online application form are correct and if at any stage of the recruitment process including after recruitment or joining, it
is detected that I have provided wrong information or submitted false documents or suppressed relevant information and do not meet the eligibility criteria of this
advertisement, my candidature will stand rejected without any notice.

I agree to abide by the rules and regulations of Nuclear Power Corporation Of India Limited, Mumbai.

..................................................

D Gen Dt.5/11/2016 11:23:34 PM Signature of the Applicant

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