Recruitment of 500 Assistants nicl

National Insurance Company Limited
130138
Recruitment of 500 Assistants
Registration Number : 546064049
Full Name : Chinmoy Kumar Barman
Vacancies of State/UT you are applying for : West Bengal
Do you have knowledge of Reading, Writing and : YES

Speaking of Regional Language of the State / UT that
you wish to apply ?
Regional Language of the State : Bengali
Category : SC
Are you a person with benchmark disability of 40% and : NO

above ?
Type of Disability : -
Nature of Disability : -
Do you need compensatory time at the time of : -

examination ?
Are you suffering from cerebral palsy and your writing : -

speed is permanently affected ?
If yes, do you need compensatory time at the time of : -

examination ?
Whether your dominant (Writing) hand is permanently : -

affected ?

examination ?
Do you intend to use the services of a scribe ? : -
Are you a person with specified disability covered under : NO

the definition of sec 2(s) of the RPwD Act, 2016 and not
covered under sec 2(r) of the said act and having
difficulty in writing ?

examination ?
Are you a person with specified disability covered under : -

the definition of sec 2(s) of the RPwD Act, 2016 and not
covered under sec 2(r) of the said act and wish to avail
the services of Scribe ?
I certify that, I will produce the certificate from : -

competent medical authority of a Government
healthcare institution as per Ministry of Social Justice
and Empowerment, Department of Empowerment of
Persons with Disabilities (Divyangjan) circular no F. No.
29-6/2019-DD-III dated 10.08.2022.
Are you Widows, Divorced women and women legally : NO

separated from their husbands who have not remarried
?
Are you Existing Employees of National Insurance : NO

Company Limited ?
Salary Roll No : -
Office Code No. : -
Are you an Ex-Serviceman ? : NO
Are you a Disabled Ex-Serviceman (DISXS) ? : NO
Period of Service (in months) : -
Date of Discharge : -
Have you joined a Government job on the civil side after : -

availing of the benefits given as an ex-serviceman ?
Are you a Dependent of Serviceman killed in Action : NO

(DXS) ?
Religion to which you belong : Hindu
Do you belong to Religious Minority Community ? : NO
Nationality / Citizenship : Indian
Phase -I: Preliminary Examination
State /UT to which Exam centre belong : West Bengal
Centre of Examination : Kolkata/ Greater Kolkata
Phase -II: Main Examination
State /UT to which Exam centre belong : West Bengal
Centre of Examination : Kolkata/ Greater Kolkata
Application Fee / Intimation charges
Payment In : ONLINE
Fees : 84.74
Tax : 7.63 (CGST) + 7.63

(SGST)
Amount : 100.00
Payment Status : PAID
Reference ID : YHMP2475802714
Transaction Date : 11-11-2024
Personal Details
Date of Birth : 26-01-2002
Age completed as on 01.10.2024 : 22
Do you have twin brother / sister ? : NO
Gender : MALE
Name of the twin : -
Gender of the twin : -
Marital Status : Unmarried
Father's Name : Bijoy Kumar Baman
Mother's Name : Chandana Barman
Spouse's Name : -
Address for Correspondence
Address 1 : Birgram
Address 2 : Chainagar
Address 3 : Hemtabad
District : Uttar Dinajpur
State : WEST BENGAL
Pincode : 733156
Permanent address
Address 1 : Birgram
Address 2 : Chainagar
Address 3 : Hemtabad
District : Uttar Dinajpur
State : WEST BENGAL
Pincode : 733156
State for GST invoicing : Permanent Address

(WEST BENGAL)
Contact Details
Mobile No : +91 6296677927
Alternative Number : +91 8759079095

(Mobile No/Landline No)
Email ID : [email protected]
Educational Qualification (as on 01.10.2024)
Exam Passed Degree/ Subject / Stream Date of % of Marks Class / Grade

Passing
Graduation Others - BMLT 17-10-2023 68.05 Second Class
Other Details :
Do you wish to avail the benefit of online pre- : YES

examination training ? (SC/ST/OBC/PWBD) :
Languages Known Read Write Speak
Bengali YES YES YES
English YES YES YES
Hindi YES NO YES
Uploaded Document Details :
1. Left Thumb Impression
2. Hand Written Declaration
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 untrue or incorrect at any stage or I am not
satisfying any of the eligibility criteria stipulated, and also in case of creating influence/undue pressure regarding recruitment
shall tantamount to cancellation of my candidature.
Date: 09-11-2024
Left Thumb Impression

Hand Written Declaration

Recruitment of 500 Assistants nicl

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National Insurance Company Limited

Registration Number : 546064049

Full Name : Chinmoy Kumar Barman

Vacancies of State/UT you are applying for : West Bengal

Do you have knowledge of Reading, Writing and : YES

Regional Language of the State : Bengali

Are you a person with benchmark disability of 40% and : NO

Do you need compensatory time at the time of : -

Are you suffering from cerebral palsy and your writing : -

If yes, do you need compensatory time at the time of : -

Whether your dominant (Writing) hand is permanently : -

If yes, do you need compensatory time at the time of : -

Do you intend to use the services of a scribe ? : -

Are you a person with specified disability covered under : NO

If yes, do you need compensatory time at the time of : -

Are you a person with specified disability covered under : -

I certify that, I will produce the certificate from : -

Are you Widows, Divorced women and women legally : NO

Are you Existing Employees of National Insurance : NO

Office Code No. : -

Are you an Ex-Serviceman ? : NO

Are you a Disabled Ex-Serviceman (DISXS) ? : NO

Period of Service (in months) : -

Have you joined a Government job on the civil side after : -

Are you a Dependent of Serviceman killed in Action : NO

Religion to which you belong : Hindu

Do you belong to Religious Minority Community ? : NO

Nationality / Citizenship : Indian

Phase -I: Preliminary Examination

State /UT to which Exam centre belong : West Bengal

Centre of Examination : Kolkata/ Greater Kolkata

Phase -II: Main Examination

State /UT to which Exam centre belong : West Bengal

Centre of Examination : Kolkata/ Greater Kolkata

Application Fee / Intimation charges

Tax : 7.63 (CGST) + 7.63

Payment Status : PAID

Transaction Date : 11-11-2024

Date of Birth : 26-01-2002

Age completed as on 01.10.2024 : 22

Do you have twin brother / sister ? : NO

Gender of the twin : -

Marital Status : Unmarried

Father's Name : Bijoy Kumar Baman

Mother's Name : Chandana Barman

Address for Correspondence

District : Uttar Dinajpur

State : WEST BENGAL

District : Uttar Dinajpur

State : WEST BENGAL

State for GST invoicing : Permanent Address

Mobile No : +91 6296677927

Alternative Number : +91 8759079095

Educational Qualification (as on 01.10.2024)

Exam Passed Degree/ Subject / Stream Date of % of Marks Class / Grade

Graduation Others - BMLT 17-10-2023 68.05 Second Class

Do you wish to avail the benefit of online pre- : YES

Bengali YES YES YES

English YES YES YES

Hindi YES NO YES