To:

PLEASE AFFIX
Chief Manager (HR), YOUR RECENT
NSIC Limited, “NSIC Bhawan”, PASSPORT SIZE
Okhla Industrial Estate, New Delhi-20 PHOTOGRAPH
AND SIGN
ACROSS

In response to your advertisement in Employment News dated___________, I submit my

Application in the prescribed format.
1. FULL NAME IN BLOCK LETTERS:
Mr. /Ms.:

2. FATHER’S/HUSBAND’S NAME IN BLOCK LETTERS:

Mr. /Ms.:

3. SEX : MALE FEMALE

4. DATE OF BIRTH : DD MM YYYY

AGE (As on 01.01.2009): ___________ Years

5. CATEGORY TO WHICH YOU BELONG :

Write SC/ST/OBC/GEN in the box as applicable

6. PERMANENT ADDRESS FOR CORRESPONDENCE:

7. PRESENT ADDRESS FOR CORRESPONDENCE:

8. NATIONALITY ___________________ RELIGION ____________________

9. YOUR CONTACT NO.:

STD Code No. Telephone No. Mobile No.

E- Mail Address
 10. GENDER : MALE FEMALE

11. EDUCATIONAL / PROFESSIONAL QUALIFICATIONS:

(from 10th Standard onwards as on 01.01.2009)

Name of the Name of Board/ Year of Core Subjects other than Class/ % of
Particulars
Degree University passing languages studied Division Marks

X Standard

XII Standard

Graduation

Post
Graduation

DECLARATION

I hereby declare that all the statements made in this application are true, complete and
correct to the best of my knowledge and belief. I understand that in the event of any
information being found false or incorrect at any stage or not satisfying the eligibility criteria
according to the requirements of the relative advertisement, my candidature / appointment is
liable to be cancelled/terminated. I am willing to serve anywhere in India. I agree that Bank
has right to transfer me to any part of the country at its discretion.

Place :_____________

Date :__________ Signature of applicant