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Application Form

Application Number : 20170701/DM002/02077

Applied Post : Deputy Manager

Applied Functional Area : Technology

Applicant Name : Mr. Bhaskar Rahul Nandi

Father Name : Mr. Prakash Kumar Nandi

Email : techbhaskar@gmail.com

Phone Number : 9987268945

Category : General

Whether Ex-Serviceman : No

Whether PWD : No

Date of birth : 06-04-1983

Aadhaar Number : 634033098352

Marital Status : Married

Minority : No

Gender : male

Current Address : B603 Nandini spingfield Takle nagar Pune-solapur Road Manjri, Pune, Maharashtra,
PIN Code : 412307

Permanent : Behind shani mandir Panchvati colony Rajkishore nagar, Bilaspur, Chhattisgarh, PIN
Address Code : 495006

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Educational Qualifications

Qualification Course Specialization Board/University Duration Passing Qual. Marks

Date Type

10th /Equivalent ICSE 1 31-05-1999 Full 62

Time

12th /Equivalent MP board 1 31-05-2001 Full 56

Time

Graduation BTech Mechanical Bharati 4 20-11-2006 Full 58

Vidyapeeth Time
University

Post-Graduation/Master's Degree

Qualification Course Specialization Board/University Duration Passing Qual. Marks

Date Type

M.Tech Indian Institute of 2 16-06-2008 Full 80

Technology Time
Kharagpur

Work Experience

S.No. Name Of Designation From To Job Profile Gross

Employer Salary(PM)

1 Siemens ltd Senior 16-06-2008 18-07-2017 Design & 89343

Executive devlopment of
Compressor &
transformer

Additional Qualification / Training Attended

S.No. Qualification Name Duration Breaf Discription

1 PhD 7 Currently pursuing PhD in Technolgy field from IIT Bombay

Presently working as Permanent Employee In Govt. PSUs/Banks or Local Bodies?

No

Have you ever appeared in interview for any post in NSIC during last 3 years?

No

Payment Information

Payment Mode : Demand Draft

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DD No. : 010921

DD Date : 19-07-2017

DD Amount : 500

Bank Name : HDFC Bank

Branch Code : 000486

In Favour of : The National Small Industries Corporation Limited

Self Declaration Of Applicant

1. I declare that I have carefully read all the Guidelines mentioned along with the detailed advertisement
hosted on NSIC website
2. I have verified the above details, and the details are in order to the best of my knowledge & belief. If at any
stage during the process and or after joining the service it is found that any material evidence/information is
falsified or suppressed or fabricated by me, my candidature, appointment will be terminated.
3. I understand that merely filling this Application Form will not be treated a complete application. Therefore, I
further declare that I will send this Application Form with self-attested copies of all documents as per pt. 5 of
“How to Apply” (pt. III of Guidelines) to GM (HR), NSIC Ltd. so that the same is received on or before
21/07/2017 upto 6.00 p.m.

Place of Submission*:--------------------------------------- Signature of the

Applicant*:--------------------------------------
Date of Submission*:----------------------------------------

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