Ugbknov11 30425

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Recruitment of Officer Scale-I and Office Assistant

14034
Please paste your recent passport size photograph and sign across it. Please retain atleast 5 copies of same photograph with you for subsequent use.

Registration #: Full Name : Post : Post Code : Category : If Person with Disability : Type of Disability : Percentage of disability :

30425 Rajendra Prasad Officer Scale-I 01 SC NO -

Do you intend to use the services of a scribe (only for VI & OC candidates whose writing speed is affected by cerebral palsy) : NA Are you candidate who had ordinarily been domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989 : Whether you belong to Religious Minority Community : Religion to Minority Religion : Are you an Ex- Serviceman? : Actual Period of service rendered in defence services as an Ex Serviceman (in months) : Are you Employees who have completed 5 years of service in RRBs? : Are you seeking Relaxation under Widows/Divorced women & women judicially separated from their husbands & who are not remarried : Domicile of Uttarakhand : Nationality : Centre of Examination : Centre code : Application Fee / Postal Charges Details : Payment In : Journal No : Branch Name : Branch Code : Deposit Date : Amount : State Bank of India 012750468 Tanakpur 1872 22-12-2011 75 NO NO -NO -NO NO YES Indian Haldwani 15

Personal Details : Date of Birth : Age completed (as on 31-10-2011): Gender : Father's Name/Husband's Name : Mother's Name : Address for Correspondence : 18-06-1990 21 MALE Ram Prasad Janki devi Kumaun Moter Warkshop Ward No. - 6 Tanakpur District : State : Pin code : Permanent Address : Champawat UTTARAKHAND 262309 Kumaun Moter Warkshop Ward No. - 6 Tanakpur District : Champawat

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State : Pin code : UTTARAKHAND 262309

Contact Details: Phone Number : Mobile Number : Email ID : Qualification Details (as on 31.10.2011): Exam Passed Graduation : Working Knowledge of Computers : Other Details : Would You like to undergo Pre-Exam Training (SC/ST/Minority Communities): If Yes ,Centre for Training : YES Dehradun Languages Known Hindi English Read YES YES Write YES YES Speak YES YES Name of the Course / Degree BA Year of Passing 2011 % of Marks 45.00 YES Class/Grade Second Class 9045612466 [email protected]

DECLARATION:
I hereby certify that the information furnished above is correct to the best of my knowledge and belief. I have not suppressed any material fact or factual information in the above statement. I am aware, that, in case, I have given wrong information or suppressed any material fact or factual information or, I do not satisfy the eligibility criteria according to the advertisement, then my candidature will be rejected/services terminated even after permanent employment without giving any notice or reasons thereof. I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of the advised criteria in respect of age, educational qualification and experience, etc. I am also willing to serve anywhere in India. I agree that the Bank has the right to transfer me to any part of the country and/or to any job position at its sole discretion in terms of applicable staff rules from time to time. I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of this application or out of said advertisement can be instituted by me only at DEHRADUN and Courts/Tribunal/ Forums at DEHRADUN only, shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank.

Place: Date: 22-12-2011 Signature of Applicant

Rajendra Prasad

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank

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