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Registration # : 271598 Please paste your

recent passport size
photograph and sign
Full Name : Neelam Bharti across it.Please retain
atleast 5 copies with
you for subsequent
Category : SC use.

Person With Disability : NO

Type of Disability : -- Percentage of Disability: --

Do you intend to use the services of a --

scribe(only for VI & OC candidates whose
writing speed is affected by cerebral
palsy)? :
Whether domiciled in Kashmir Division of NO
the State of J&K during the period
1-1-1980 to 31-12-1989 :
Belongs to Religious Minority Community : NO Minority Religion : --

Are you an Ex-Serviceman ? NO Are you Disabled NO

Ex-Serviceman (DISXS)?

Period of Service in the Defence forces (in -

months) :

Are you Dependent of an Ex-Serviceman NO

(DXS)? :

Are you seeking relaxation under widow NO

/divorced women / women judicially
Separated from their husbands and who
are not re-married? :
Nationality : indian

State / Union Territory for which you are Uttar Pradesh UT Centre code : 24
applying :

Centre of Examination : Lucknow Centre code : 54

Application Fee / Postal Charges Details

Transaction Id : M132238

Branch Name : Hazrat Gunj Lucknow

Branch Sol ID : 0302

Deposit Date : 13/09/10 Amount : 50

Personal Details :
Date of Birth : 13/12/1984 Age as on 01.07.2010 : 25

Gender : Female

Father’s Name : Ram Swaroop

Mother’s Name : Rajvati Devi

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Marital Status : Married

Spouse Name(if Married) : Rajesh Kumar Gautam

Email ID :

Address for Correspondence : Q.No. M/6

Old Railway Colony Aishbagh


District : Lucknow

State : UTTAR PRADESH Pin: 226004

Permanent Address: Q.No. M/6

Old Railway Colony Aishbagh


District : Lucknow

State : UTTAR PRADESH Pin : 226004

Phone : 0522-6452393 Mobile : 9807194410

Qualification Details(as on 01.07.2010):

Exams Passed Subject / Stream University / Board Year Of Passing % of Marks
HSC / Equivalent : Arts U.P. Board Allahabad 2001 51.20
Graduation : Arts Lucknow University 2004 56.20
Others : M.A. Lucknow University 2006 56.60

Whether undergone Computer Course for YES

three months :

Other Details:
Whether desirous of taking Pre-Exam NO Centre for Training : --
Training (SC/ST/Ex-Servicemen/Religious
Minority Community) :

Languages Known Read Write Speak


I hereby certify that the above information furnished 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 or claims or disputes arising out of application or out of said advertisement can
be instituted by me only at Kolkata only, shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms
and conditions in the advertisement given by the Bank.

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Place : Signature of Applicant
Date : 19/09/10

Neelam Bharti
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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