BIO DATA FORM TO BE SUBMITTED FOR CONSIDERING ABSORPTION IN
TERMS OF THE CGIT AWARD DATED 18.06.2001 IN ID 27 OF 1991
(ALL THE FIELDS TO BE FILLED IN ENGLISH AND IN CAPITAL LETTERS)
1. Name in Full (In English, Capitals)- First Name, Middle Name
and Last Name (Surname)
2. Sex: Male/ Female
3. Date of Birth :
DD MM YYYY
Age as on 01.07.2015:________ (Proof for Date of birth to be enclosed)
Marital Status: Married Unmarried Others
(Specify)
:
4. Fathers Name: ______________________________
5. Name of the Spouse: _____________________________________
6. Category (indicate by marking {X } in the appropriate box)(Proof to be enclosed)
S.C. S.T. O.B.C. GENERAL
Are you an Ex-serviceman ? Yes/No If yes, Date of Discharge: No. of Yrs served
For Physically Handicapped Candidates Only
Whether Degree of Whether copy of Medical
Orthopedically Handicapped/ Impairment Certificate in the proper
Hearing Impaired/Visually Impaired (%) format is enclosed
7. Religion: _________________
Whether belonging to Minority Community. If yes, please mark (X) below:
Muslims Christians Neo Buddhists Sikhs Zoroastrians
8. Mailing Address with Pin Code
District STATE PIN CODE
1
Mobile________________________E-mail id: _______________________
Landline STD Code : _____Telephone No_______________
AADHAR NUMBER
9. Permanent Address: Whether permanent address is different from the mailing
address? YES/NO. If Yes, fill the following:
District STATE PIN CODE
10.(a). Details of Employment in LIC: (SELF ATTESTED COPIES OF THE PROOF OF THE
EMPLOYMENT TO BE SENT WITH THIS APPLICATION. OTHERWISE THE APPLICATION
WILL BE REJECTED AT THE INITIAL STAGE ITSELF)
Proof attached
No. Of Pages
Employment
D. O /ZO/CO
Appointment
Name of the
Name of the
Number of
Issued the
Appointed
Nature of
Period of
worked-
Code Of
Date of
worked
worked
where
Letter
for the
Office
Office
S.No.
Days
letter
Post
the
and
From To
10 (b) Details of the petition in the CGIT (ID27/1991) If you are the petitioner in the said ID
27/1991, please provide the details:
11. Educational Qualifications: ______________________________
(Self attested copies of the certificates to be enclosed)
Examination Name of the Board/ Month & Year Aggregate
Passed University/School of Passing Marks
SSC
HSC
Graduation
Post Graduation
Others-Specify
2
12. Work Experience: (Present and Past) No. of Years ________Months______
Name of the Employer Tenure of Post occupied Reasons for
Employment Leaving
From To
13. Languages Known
Language Write Read Speak
14. Have you ever been prosecuted, detained, fined, convicted or awarded any sentence by any
court of law for any offence or any case is pending against you? YES/NO
If so, please give full details.
15. Any other information.
DECLARATION:
I hereby declare that all the statements made in this Application hereinabove are true
and correct to the best of my knowledge and belief. I understand that in the event of
any information being found false, incorrect or incomplete or if I am found ineligible
due to non-fulfillment of eligibility criteria, my candidature for the absorption is liable
to be cancelled /rejected at any stage of the process
Date : (Signature of the Applicant)
Place :
(All questions have to be answered. No Question shall be left blank. Give brief and correct
answers. If the reply to any question needs more space, details should be given in separate paper
duly signed)
The eligible concerned workmen are requested to submit the Bio data in the above
format along with the self attested copies of the documents to the address mentioned
below to reach on or before 21.08.2015:
LIC of India,
Post Box No 11511
Nariman Point Post Office
Mumbai Pin 400021.
