FORM-01

CASH ONLY

BRANCH COPY

CASH ONLY

CANDIDATE COPY

STATE BANK OF INDIA

STATE BANK OF INDIA

UTKAL GRAMEEN BANK RECRUITMENT ACCOUNT

FOR THE POST OF OFFICER SCALE-

UTKAL GRAMEEN BANK RECRUITMENT ACCOUNT

FOR THE POST OF OFFICER SCALE-..

Name in Full :
(In CAPITALS)
DATE OF
BIRTH

Name in Full :
(In CAPITALS)
D

DATE OF
BIRTH

APPLICATION FEE CAN BE DEPOSITED IN BELOW MENTIONED

ACCOUNT OF ANY BRANCHES OF STATE BANK OF INDIA

APPLICATION FEE CAN BE DEPOSITED IN BELOW MENTIONED

ACCOUNT OF ANY BRANCHES OF STATE BANK OF INDIA

NAME OF THE BANK

ACCOUNT NO

NAME OF THE BANK

ACCOUNT NO

STATE BANK OF INDIA

34038828495

STATE BANK OF INDIA

34038828495

Category of
Candidate
SC / ST / PWD/ EXS
All others

OFFICER SCALE-I & II

DETAILS OF DEPOSIT
Amount of Fee Deposited

Rs.20/Rs.100/-

Category of
Candidate
SC / ST / PWD/ EXS
All others

OFFICER SCALE-I & II

Rs.

DETAILS OF DEPOSIT
Amount of Fee Deposited

Name of the Branch

Name of the Branch

Branch Code

Branch Code

Date of Deposit

Date of Deposit

Journal No.

Journal No.

(Applicants Signature)
Address ;

(Authorised Signatory of the Bank)

SS No.
Branch Seal :

(Applicants Signature)
Address ;

Affix Passport size

Photograph and
sign across

Rs.20/Rs.100/-

Rs.

(Authorised Signatory of the Bank)

SS No.
Branch Seal :

Mobile No.

Mobile No.

Tick () whichever is applicable.

Fee receiving branch is requested to write clearly & legibly
the, BRANCH CODE NO. & JOURNAL NO. invariably.
(This challan will be required to be submitted by the candidate at the time of
INTERVIEW , otherwise the candidate will not be allowed to appear in the interview)

Tick () whichever is applicable.

Fee receiving branch is requested to write clearly & legibly
the, BRANCH CODE NO. & JOURNAL NO. invariably.
(This challan will be required to be submitted by the candidate at the time of
INTERVIEW, otherwise the candidate will not be allowed to appear in the interview)