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Coastal Local Area Bank Ltd.

Corporate Office: Vijayawada

Application for the post of an Officer in Coastal Local Area Bank Ltd.
(To be filled by the candidate in his handwriting)

Name of the candidate : Latest

Passport size
Father’s/Husband’s name : (Signature
Date of Birth : the photo)

Age as on 30.09.2010 :

Present address with contact

number & mail id :

Permanent address :

Gender : Male/Female

Caste : SC/ST, BC, OC

Religion :

Nationality :

Marital Status :
Educational Qualifications: (School to P.G)
Name of the
institution Qualification Rank/Grade,
Year Marks %
( Regular acquired If any

(Degrees acquired through regular college studies are only considered)

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Knowledge in Computers
(Qualification if any) :
Languages :
Fluency Telugu English Hindi

Special achievements, if any:

Previous experience, if any:

Last salary drawn

Name of the Organization Post held Duration Nature of duties
(Gross per month)
From To Rs.

Two references from respectable persons : (Name and complete address with contact
1) 2)

I declare that the information furnished above is true and correct. I declare that I have sound
health and I am fit for employment. I also declare that I do not have any criminal or any such
other cases against me either previously or now. I confirm that I have read carefully the norms
for employment and understood the terms before applying for the post. I am aware that at a later
date if any information furnished by me is proved to be wrong, I am liable to be removed from
the employment.

Date: Signature of the Candidate

Enclosures: Photo‐copies of
a) Educational qualification certificates/degrees.
b) High school leaving certificate indicating proof of date of birth.
c) Two pass port size photographs, in addition to the one pasted on this application.
d) Ration card of the family in which the name of the candidate is mentioned.
e) Voter ID ( or) Driving licence
(Note: Originals to be produced at the time of selection process/interview)

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