Kurmanchal Nagar

Sahkari Bank Ltd.

Application Form
Tick your Examination Centre Region

Haldwani

or

Dehradun

(Please fill-in with black ink & use Capital Letters except for email ID)
1. Name

(Sh/Km/Smt):___________________________________________________

2. Fathers / Husbands name:___________________________________________

3. Date of Birth

(dd/mm/yyyy):______________

Affix passport
size photo

(Age as on 30-04-2012): Years___ Months___

4. Qualification at Graduation Level:

(a) B.A / B.Com / B.Sc. /Other Equivalent:_________________________________________
(b) Year of Passing :___________
(c) University/Institution:______________________________________________________
(d) Marks:________ out of______

(e) %age of marks:______ %

5. Details of additional qualifications passed, if any:____________________________________

6. Computer Skills:______________________________________________________________
7. Category (please write SC/ST/OBC/General, as the case may be):_________________________
8. Address, Telephone no. & E-mail:
(a) Correspondence:___________________________________________________________
__________________________________________PIN:_____________
(b) Permanent:_______________________________________________________________
______________________________________________PIN:______________
(c) E-mail ID:_________________________________________________________________
(Please maintain an active email ID for atleast 3 months from the date of advertisement)

(d) Mobile No:______________________

(e) STD code & Tel No:________

_____________

9. Application Reference No. :____________________________ (to be filled by the bank official)

I hereby undertake that all the information furnished by me is true to the best of my knowledge.
Anything found false at any point of time will lead to cancellation of my candidature / appointment &
application fee forfeited.

Signature of Candidate

Place

-------------------------------------------- cut here -----------------------------------------Application Reference No. :____________________________ (to be filled by the bank official)
Name:_________________________________________________________________________
Application Fee:
paid thru:

Rs. 300/-

Rs. 100/-

cash / cheque / pay order / dd no._________________________

dated:____________ at (branch):_____________________

(Signature of bank official)

with date & stamp