Application Form

for the Post of Procurement Inspector

Orissa State Civil Supplies Corporation Ltd.
( A Government of Odisha Undertaking)

PI-34121

Applicant Copy(To be retained by the applicant)

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Applicant's NameANANTA NARAYAN SWAIN

Father's Name AKSHAYA KUMAR SWAIN
Mother's Name RENUBALA SWAIN
Male
Gender
03-Aug-1989
Date Of Birth

Affix a recent
passport size,self
attested Color
Photograph.

6. Present Address for Communication

ORISSA
a. State :
b. District : KHURDA
QR NO- 3 R-1, RIE CAMPUS, BHUBANESWAR,Pincode: 751022
c. Address :
d. Telephone : 0674 - 2543401 e. Mobile : 9778393303
f. e-Mail : ans_gulu@yahoo.co.in
7. Permanent Address
ORISSA
a. State :
b. District : JAGATSINGHPUR
VILLAGE- MAJURAI, POST- REDHUA, PS-RAGHUNATHPUR,Pincode:
c. Address :
d. Telephone : 0674 - 2543401 e. Mobile : 9778393303
8. Reservation/Category Details
Category :
General(Unreserved)
Person With Disability : No
Sports Person:
9.

Ex-Service Man :
No
In-Service Applicant
No
:

No

Qualification Details

Year of
Passing /
Total
Aggregate
Degree / Diploma with
Examination
Board/University Award Mark/Grade Mark/CGPA
Specialisation
of
Point
Secured
Degree
HSC
CBSE
2004
66
66
+2
ARTS
CBSE
2006
72
72
BACHELOR IN
UTKAL
DEGREE
BUSINESS
2009
67
67
UNIVERSITY
ADMINISTRATION
10. Application Details
User Id : PI-34121

Password
99595
:

NB : Your Online application has been submitted successfully.

Please send the OSCSC Copy along with enclosures to Orissa State Civil Supplies Corporation Limited
,C/2 Nayapalli, Bhubaneswar-751012, Odisha. by 28-July-2011 by Registered Post/SpeedPost.
1

Application Form
for the Post of Procurement
Inspector

PI-34121

Orissa State Civil Supplies Corporation Ltd.

( A Government of Odisha Undertaking)

OSCSC Copy
(To be sent to OSCSC Ltd,C/2,Nayapalli,Bhubaneswar-751012,Odisha Through Registered
Post/Speed Post Only)
1
2
3
4
5

Applicant's NameANANTA NARAYAN SWAIN

Father's Name AKSHAYA KUMAR SWAIN
Mother's Name RENUBALA SWAIN
Male
Gender
03-Aug-1989
Date Of Birth

Affix a recent
passport size,self
attested Color
Photograph.

6. Present Address for Communication

ORISSA
a. State :
b. District: KHURDA
Address
:
QR
NO3
R-1,
RIE
CAMPUS, BHUBANESWAR,Pincode: 751022
c.
d. Telephone : 0674 - 2543401 e. Mobile : 9778393303
f. e-Mail : ans_gulu@yahoo.co.in
7. Permanent Address
ORISSA
a. State :
b. District: JAGATSINGHPUR
VILLAGE- MAJURAI, POST- REDHUA, PS-RAGHUNATHPUR,Pincode:
c. Address :
d. Telephone : 0674 - 2543401 e. Mobile : 9778393303
8. Reservation/Category Details
Category :
General(Unreserved)
Person With Disability : No
Sports Person:
9.

Ex-Service Man :
No
In-Service Applicant
No
:

No

Qualification Details

Year of
Passing /
Total
Aggregate
Degree / Diploma with
Examination
Board/University Award Mark/Grade Mark/CGPA
Specialisation
of
Point
Secured
Degree
HSC
CBSE
2004
66
66
+2
ARTS
CBSE
2006
72
72
BACHELOR IN
UTKAL
DEGREE
BUSINESS
2009
67
67
UNIVERSITY
ADMINISTRATION

Enclosures (Copies of following documents is to be submitted along with this Application form to Orissa
State Civil Supplies Corporation Limited,C/2,Nayapalli,Bhubaneswar-751012,Odisha)
Instruction : Put a (
Sl#
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2
3
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9
10
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15

) for the attched relevant document in the following List .

Documents

Proof showing the applicant has passed Oriya language test up to 7th standard or above.
Self attested copy of HSC or equivalent certificate issued by Board/Council for date of Birth
verification.
Self attested copy of HSC Mark Sheet
Self attested photocopy of 10+2 or equivalent certificate .
Self attested photocopy of 10+2 mark sheet.
Self attested photocopy of Degree or equivalent certificate .
Self attested photocopy of Degree mark sheet.
Self attested photocopy of permanent resident certificate from revenue officer not below the rank of
Tahasildar/ Additional Tahasildar.
Self attested photocopy of caste certificate for employment purpose issued by competent authority, if
belongs to SC/ST/SEBC.
One recent self attested color photograph (3.5 x 4.5 size) should be affixed at the space provided.
Certificate of experience issued from the OSCSC head office in case of inservice applicant.
In case of Ex-servicemen, a self attested copy of discharge certificate and the document indicating the
period of service rendered in armed forces.
In case of person with disability self attested copy of certificate issued by competent authority.
In case of sports person self attested copy of Identity card/Certificate issued by Director of
Sports,Orissa.
The applicants other than belonging to SC/ ST / PH / OH category are required to send a Demand
Draft of Rs. 50.00 (Rupees Fifty only) drawn in favour of Orissa State Civil Supplies Corporation
Limited payable atBhubaneswaralong with the application form.

DECLARATION
I hereby declare that all the statements made in the application are true and complete to the best of my
knowledge and belief,in the event of any information being found false or incorrect at any stage my
candidature appointment shall be liable to be cancelled without any notice.
Date :
Place :

Signature of Applicant

2
Sender

By

Regd. Post

Application for the Post of : Procurement Inspector

From
Name

ANANTA NARAYAN SWAIN

Father's Name

AKSHAYA KUMAR SWAIN

Plot No, / Lane Name /

QR NO- 3 R-1, RIE CAMPUS,

Village

BHUBANESWAR

District Name

KHURDA

PIN Code

751022

Speed Post

To

The General Manager [Admin]

Orissa State Civil Supplies Corporation
Limited
C/2 Nayapalli,
Bhubaneswar,
Orissa, PIN: 751012