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ON-LINE APPLICATION FOR RECRUITMENT FOR THE POST OF Officer MMG SCALE-III,II,JMG SCALE-I CADRE & OFFICE ASSISTANT

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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 # : Full Name : Post : Post Code : Category : If physically Challenged : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe(only for VI and OC both hands affected by cerebral palsy) :

15627 Garlapati Harish Kumar Officer JMGS - I 03 GENERAL NO NA

Whether domiciled in Kashmir Division of the State of, J&K during the period 1-1-1980 to 31-12-1989 : NO Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex-Serviceman/Commissioned Officers (including ECOs/SSCOs) ? : Are you a disabled Ex-Serviceman (DISXS) ? : Are you an Dependent Ex-Serviceman killed in Action (DXS) ? : Actual Period of service rendered in defence services as an Ex-serviceman (in months) : Are you Children / Family members of those who died in the 1984 riots ? : Domicile of Andhra Pradesh State : Nationality : Centre of Examination : Centre code : Application Fee / Postal Charges Details : Payment In: Branch Transaction ID/Scroll No : Syndicate Bank Branch Name : Branch Code Numeric : Date of Deposit : Amount : SYNDICATE BANK 97 Hyderabad SanjeevareddyNagar 3055 13-10-2011 300 NO YES Indian Ongole 15 NO -NO NO NO

Personal Details : Date of Birth : Age completed (as on 31.08.2011) : Gender : Marital Status : Husband's Name/Father's Name : Mother's name : Address for Correspondence : 02-07-1989 22 MALE UnMarried Garlapati RamasubbaRao Garlapati Subhashini DoorNo 8-22A MainRoad Kurichedu District : State : Prakasam ANDHRA PRADESH

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Pin : Permanent Address : 523304 DoorNo 8-22A MainRoad Kurichedu District : State : Pin : Contact Details: Phone No : Mobile No : Email ID : Qualification Details (As on 31.08.2011): Exam Passed Graduation : Others : Working Knowledge of Computers : Details of Computer Knowledge: Post Qualification work experience details if any as on 31.08.2011 (Start from present Employer): Name of the Employer & Nature of Employment Designation and Rank From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Reason for Leaving Years of Service (YY/MM) Name of the Course / Degree Computer Science Diploma Dotnet Year of Passing 30-07-2010 30-03-2011 YES c language and sqlserver % of Marks 61.55 60.00 Class / Grade First Class First Class 08408-276384 9642495657 harish.143k@gmail.com Prakasam ANDHRA PRADESH 523304

Total Experience (in months) : Languages Known Telugu English Other Details : Whether desirous of taking Pre-Exam Training (Only for SC/ST/Minority) : If Yes ,Centre for Training : --Read YES YES Write YES YES

Speak YES YES

DECLARATION:
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/ service 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 advised criteria in respect of age, caste, educational qualification etc. 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 atKadapaand courts/ Tribunal/ forums atKadapaonly, shall have sole and exclusive jurisdiction to any cause/ dispute. I undertake to abide by all the terms and conditions in the advertisement given by the Bank.

Place: Date: 14-10-2011 Signature of Applicant

Garlapati Harish Kumar

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