Career form – NHIPMPL

APPLICATION FORMAT (TO BE FILLED IN ENGLISH CAPITAL LETTERS)

Name of the Post *
Name of the Candidate *
Date of Birth (copy of proof to be enclosed) *
Age as on last date of receipt of application *
Gender (Male / Female) *
Father’s / Husband’s name *
Address for Correspondence *
Permanent Address *
Aadhar No. *
Email *
Mobile No. *
Alternate No. *
Date of superannuation (in the case of retired Govt. Officials)
Current Pension drawn per month (Copy of Pension Order to be attached) (If applicable)
Photo *
Signature *
Upload Documents (10 MB Zip file) *
DECLARATION I have carefully gone through the vacancy circular / advertisement and I solemnly declare and undertake that all the information furnished by me is true, correct and complete to the best of my knowledge and belief. I undertake that, if at any stage of the selection or even after selection, any of the information furnished by me is found to be false, incorrect or misleading, then my service/engagement will stand cancelled / terminated without assigning me any reason. I will produce the original documents in support of the information furnished when so ever required by the employer. I also certify that there is no conflict of interest with any concessionaires / stakeholders / staff associated with NHIPMPL.
Date : *
Place :