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ONLINE APPLICATION FORM FOR THE POST OF PROBATIONARY ASSISTANT MANAGER JMGS-I 2010

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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 # : 151222
Full Name : NAVNEETH VASU KOTIAN
Category : UR
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)?
Are you a candidate who
had ordinarily been domiciled in Kashmir Division
NO
of the State of J&K during the
period 1-1-1980 to 31-12-1989 :
Whether you belong to The Children/Family Members
NO
of Those who had died in 1984 Riots:
Are you an Employee of Vijaya Bank? NO
Applying for higher
Employee Number/ Staff Code: - -
grade/scale?
Whether you belong to Religious Minority Community? NO
Religion to which you belong :
Are you an Ex-Serviceman ? NO
Nationality : INDIAN
Choice of Centre for Examination : : Mumbai

Centre code : 22

Application Fee / Postal Charges Details :

Transaction ID : 0139057

Branch Name : BORIVALI

Branch Code : 5047

Deposit Date : 13/10/2010 Amount : 300

Personal Details :
Date of Birth : February 03,1986 Age as on 30.06.2010: 24
Gender : MALE

Father's Name/ Husband's Name : VASU KOTIAN

Mother's Name : LALITHA VASU KOTIAN

Contact Details:
Email ID : navneetkotian@gmail.com

Address for Correspondence : 73/10 - A NALANDA VAN CHS

MITTAL ENCLAVE JUCHANDRA

NAIGAON EAST
 2/2
District THANE

State : MAHARASHTRA Pin : 401208

Permanent Address : 73/10 - A NALANDA VAN CHS

MITTAL ENCLAVE JUCHANDRA

NAIGAON EAST
District THANE

State : MAHARASHTRA Pin : 401208

Phone No : - Mobile No : 9892367224

Educational Qualification Details (as on 30.06.2010):

Exams Passed Subject/Stream Month/Year Of Passing % of Marks

Graduation : BMS 05/2007 67.08

Knowledge of Computer : YES

Would You like to undergo

NO
Pre-Exam Training (Only for SC/ST/Minority Community) :
If Yes centre for training :

Other Details :

Languages Known Read Write Speak

ENGLISH YES YES YES

HINDI YES YES YES

TULU YES NO YES

KANNADA YES NO YES

NO NO NO

DECLARATION:
I hereby declare that 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
advertisement my candidature/appointment is liable to be cancelled/terminated at any stage and if appointed my services are liable to be terminated. I am willing
to serve anywhere in India. I agree that the Bank has the right to post me to any part of the country at its discretion.

I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of application or out of said advertisement
can be instituted by me only at Bangalore and Courts / Tribunal /Forums at Bangalore 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: 14/10/2010 Signature of Applicant

NAVNEETH VASU KOTIAN

Please retain your Registration No. and Password (sent to your Email ID) carefully for further reference.
Note : Please do not send the application print out to the Bank.