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ON-LINE APPLICATION FOR UNITED INDIA INSURANCE CO. LTD.

19026

Please paste your recent

passport size photograph
and sign across it. Please
retain atleast 5 copies of
same photograph with you
for subsequent use.

Registration # : 205318
Full Name : BOMMAGALLA PRATHAP
Group Applied for : Group E
Group Code : 05
Category : SC
If Physically Challenged : NO
Type of Disability : --
Percentage of Disability: --
Do you intend to use the services of a scribe(only for VH and OH
--
candidates whose writing speed has been affected by cerebral palsy) :
Whether domiciled in Kashmir Division of the State
NO
of J&K during the period 1-1-1980 to 31-12-1989?
Whether you belong to Religious Minority Community NO
Minority Religion : --
Are you an Ex-Serviceman (ECO/SSRCO)? NO
Are you Resident of Assam State during the period from 01.01.1980 to
YES
15.08.1985 ? :
Are you Permanent Employees of United India Insurance Co. Ltd? : NO
Please enter Your employee number : --
Designation : --
place of work : --
Are you confirmed employees of General
Insurance Corporation of India, Public Sector General NO
Insurance Companies, Tariff Advisory Committee , AICIL? :
Please enter name of company: --
place of work : --
Nationality : Indian
Centre of Examination : Bengalooru
Centre code : 73
Application fee details :
Transaction ID / Journal No. : --
Branch Name : --
Branch Code : --
Deposit Date : --
Amount : --

Personal Details :
Date of Birth : 01-05-1982 Age as on 31.12.2010. : 28
Gender : MALE
Father's Name / Husband's Name : B YEBU
Mother's Name : B MARIYAMMA
Address for Correspondence : S UPPALAPADU
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JAMMALAMADUGU
KADAPA
District KADAPA
State / UT: ANDHRA PRADESH
Pin : 516431
Permanent Address : S UPPALAPADU
JAMMALAMADUGU
KADAPA
District KADAPA
State / UT: ANDHRA PRADESH
Pin : 516431
Contact Details:
Phone No : -
Mobile No: 9490730531
Email ID : [email protected]
Qualification Details(as on 31.12.2010):

Exams Passed Name of Degree Date of Passing % of Marks Class/Grade

Graduation / Equivalent : B.Com 01-04-2004 54.00 Second Class

Post Graduation : MCA 01-06-2007 65.00 First Class

Have you passed in atleast three papers of

NO
the examination conducted Actuarial Society of India ?:
Select the papers out of : --
Working Knowledge of Computers: YES
Details of Computer Knowledge : MCA
Post Qualification work experience details (Start from present Employer):

No Experience

Total relavant years (in months) :

Languages Known Read Write Speak

ENGLISH YES YES YES

HINDI YES YES YES

TELUGU YES YES YES

DECLARATION:
I hereby declare that all the 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, my candidature for the post applied is liable to be cancelled / rejected at any stage without giving any notice
to me. I am willing to serve anywhere in India. I agree that the Company has the right to transfer me to any part of the country at its discretion.

Place:
Date: 09-02-2011 Signature of Applicant

BOMMAGALLA PRATHAP
Please retain your Registration No. and Password emailed to you carefully for further reference