External Candidate Application To Be Addressed: General Manager(Personnel/Recruitment) Coal India Limited 10 Netaji Subhas Road Kolkata:-700001 West Bengal

Discipline Code: Discipline Applied For: Name: Father / Husband's Name: Mother's Name: Caste: Test Center: Whether Ex-Serviceman? Defence Service From: Whether Physically Handicapped? Date of Birth Gender Acadamic Qualification: 03 Personnel Ref No:11190 Date 26-MAR-14 Prakashbhai Laxmanbhai Parmar Application No:Personnel/APR-14/2681 Laxmanbhai Parsottambhai Parmar Login Id mrprakashparmar@yahoo.in Savitaben Laxmanbhai Parmar SC Religion HINDU Mumbai No Defence I-Card No: Defence Service To: No 12-08-1991 M Degree Status Final Yr/Semester(Appearing) Graduates with at least 2 yrs full time PG degree/PG diploma/PG program in Management with Agreed: Yes %age 70.3 specialization in HR/IR/PM from recognized Indian University/Institute with minimum 60% marks Address for Communication B/59 Valmiki Society Near krunal Banlows b/h Amin Party plot Address-2 Gotri Road VAdodara Subhanpura Town/city: Pincode: 390021 Vadodara State: Gujarat Mobile: 9099547202 Permanent Address B/59 Valmiki Society Near krunal Banlows b/h Amin Party plot Address-2 Gotri Road VAdodara Subhanpura Town/city: Pincode: 390021 Vadodara State: Gujarat Mobile: 9099547202 Bank Challan Details Amount: Branch Code: Journal No: Issuing Branch: Qualification Details Year of Duration of Name of The Institute Board/University Passing Course 2013 2 Sigma Institute of Management Studies GTU, Ahmedabad Issue Date: Affix Your Recent Colour Photograph Here

Address Post Office: District: Telephone: Address Post Office: District: Telephone:

Sl No 1

Examination Passed Stream MBA Finance

Division/ %age Grade DISC 70.30

I do hereby declare that the above information as furnished by me is true to the best of my knowledge. I also give undertaking that "At any point of time if any of the above information is found false, it will automatically lead to cancellation of my candidature and will also be liable for prosecution under law". Signature of the Candidate

(Prakashbhai Laxmanbhai Parmar) Instructions to the Candidate 1. Copy of Bank Challan, where applicable 2. Relevant qualification Pass Certificate (Provisional/Final) 3. Certificate from competent authority for OBC(NCL)/SC/ST/PH where applicable 4. Copy of document in support of date of Birth(Matriculation/Any other Certificate) 5. For Internal Candidates - Photo to be attestted by the controlling officer

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6. For External Candidates - Photo should be self attestted

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