For office Use: Reg. No. _____________ Dated: _______________ Fee: _____________

BROADCAST ENGINEERING CONSULTANTS INDIA LTD

(A Govt. of India Enterprise)

Head Office: 14-B, Ring Road, I.P. Estate, New Delhi-110002

Tel : + 91(11) 23378823-25, Fax No. + 91(11) 23379885

Corporate Office: BECIL Bhawan, C-56, A/17, Sector-62, Noida 201307 Uttar Pradesh

Tel: 0120-4177850 Fax : 0120-4177879

E_Mail: contactus@becil.com Website: www.becil.com

(REGISTRATION FORM)

(Imp: Please read the details on prescribed educational, professional as well as experience requirements for the various professionals before filling in the form)

1. Application for Registration for the post of:

2. Name - Mr. / Mrs. / Miss. (Please tick the appropriate)

First Name Middle Name Last Name

3. Fathers/Husbands Name:

4. Date of Birth: Day Month Year

5. The details of the Universal Account Number (UAN) or Previous PF Member ID (if any):

UAN No.

OR

Previous PF Member ID	Region Code	Office Code	Establishment ID	Extension	Account No.

6.

Employee State Insurance No. (if any)

7.

PAN No. (If any)

8. Category: General OBC SC/ST Others

9. Marital Status: Married Unmarried

10. Nationality : ___________________________________ 11. Religion:_______________________________

12. Address for Communication:

City State

Pin Code

13. E-Mail Address (Capital Letters):

Phone No. Mobile No

(Prefix city)

Code

- 2 -

14. Educational/Professional Qualifications:

S. No.	Examination Passed	Course/Subject	Name of School/ College/University	Year of Passing	Division/ Grade
1	X
2	XII
3	Graduation
4
5
6

15. Work Experience (add separate sheet if required):

S. No.	Organization	Designation	Duration	Brief Job profile
			From	To
1.
2.
3.
4.

16. Total years of experience: __________________________

17. References

S.No.	Name	Address	Contact Number

18. If selected your preferences for location

1. ------------------------- 2. ------------------------- 3. -------------------------- 4. Anywhere in India

19. Languages known (Tick appropriate boxes)

Read Speak Write

1. ------------------

2. ------------------

3. ------------------

4. ------------------

Note: Please attach self attested photocopies of following documents with the form:

a) Educational / Professional Certificates

b) Birth Certificate

c) Caste Certificate, if any.

d) Work Experience Certificates

e) PAN Card

f) Aadhar Card

g) Copy of EPF/ESIC Card (if already have)

Signature __________________ Date __________________