Advt. No.

APPLICATION FORM

(USE CAPITAL LETTERS, LIMIT INFORMATION TO BOXES ONLY)

Post applied for
Affix
Category (please SC ST OBC GEN EX-SM PH latest
tick) Passport
Name (in block letters)
Size
Photograph
Father’s name

Postal Address with Pin

Code Number

State of Domicile Contact Tel. No.

eMail-id

Date Month Year

Date of Birth Age as on 31.08.2012

Qualification : Duration Whether Marks Total % of Month & Name of University/

(Academic, Technical of Course Regular obtained Marks marks Year of Institute/Board
or Professional Qual – (in years) Course obtained Passing
from class 10th (Yes/No)
onwards)
Post Qualification Experience as on 31.12.2018
Name of the Company / Duration of Number of Type of Assignments Handled /
Organisation where Experience specific nature of work /
worked / working duty performed
From To Years Months

Name of Issuing Bank

DD No.
Date of Issue Code No. of the Issuing Bank

I hereby declare that the particulars furnished above are complete and correct to the best of my knowledge and belief. I
understand that if at any stage, it is found that the information given in the application is false or incorrect or I do not
satisfy the eligibility criteria, my candidature / appointment is liable to be cancelled.

Date Place Signature