You are on page 1of 3

1/3

Central Bank of India Clerical Recruitment Project � 2010

31033
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 : Category : Whether person with disability : Type of Disability : Do you intend to use the services of a scribe (only for VH & OH candidates whose writing speed is affected by cerebral palsy)? : Are you a candidate who had ordinarily been domiciled in Kashmir Division of the State of J & K during the period 1-1-1980 to 31-12-1989 ? : Whether you belong to Religious Minority Community? Religion to which you belong : Are you an Ex-Serviceman ? If Ex-Serviceman, have you passed in Service (Departmental) Examination which is recognized as equivalent to Civil Examination b not below the level of Matriculation?: Are you a Disabled Ex-Serviceman (DISXS)? : Period of Service in the Defence force (in months) : Are you a Dependent of an Ex-Serviceman (DXS)? : Whether children / family members of those who died in 1984 riots ? : Are you seeking relaxation under window / divorced women / women judicially Separated from their husbands and who are not re-married? : Nationality : State / Union Territory for which you are applying : State / UT code : Centre of Examination : Centre code : Application Fee / Postal Charges Details : Transaction ID : Branch Name : Branch Code : Deposit Date :

278554
Dheeraj Kumar GENERAL NO Percentage of Disability : --

--

NO

NO

NO

NO

NO

NO NO

NO

indian Uttaranchal 26 Deharadun 44

3127948 Mohali 3262 29-11-2010 Amount : 250

Personal Details :

Place: Date: 01-12-2010 Signature of Applicant . I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of this application or out of said advertisement can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai only. then my candidature will be rejected/services terminated even after permanent employment without giving any notice or reasons thereof.2010):: dheeru11@gmail.11. in case. I have given wrong information or suppressed any material fact or factual information or.00 Class / Grade Second Class First Class Languages Known Read English Hindi Punjabi YES YES YES Write YES YES YES Speak YES YES YES Other Details : Would You like to undergo Pre-Exam Training (SC/ST/Religious Minority Community/PC/Ex-Serviceman) : If Yes Centre for Training : NO DECLARATION: I hereby certify that the information furnished above is correct to the best of my knowledge and belief.1984 MALE Sh.00 61. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank. Asha Shah C/O Shri Ram Karyana Store Near New Police Station Balongi District State : Permanent Address : Mohali PUNJAB C/O Shri Ram Karyana Store Near New Police Station Balongi District State : Mohali PUNJAB Pin : 140301 Pin : 140301 Age completed as on 01. I am aware. I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of the advised criteria in respect of age. shall have sole and exclusive jurisdiction to try any cause/dispute. Lalan Prasad Shah Smt. I have not suppressed any material fact or factual information in the above statement. educational qualification and experience.11. I agree that the Bank has the right to transfer me to any part of the country and/or to any job position at its sole discretion in terms of applicable staff rules from time to time. I do not satisfy the eligibility criteria according to the advertisement.2/3 Date of Birth : Gender : Father's Name/ Husband's Name : Mother's Name : Address for Correspondence : September 11. etc.2010. that. I am also willing to serve anywhere in India.com Mobile No : 8146524588 Exams Passed Graduation / Equivalent : Graduation / Equivalent : Knowledge of Computer : Diploma in Banking : Subject/Stream science tourism Year Of Passing 2005 2007 YES NO % of Marks 51. : 26 Contact Details: Phone No : Email ID : Qualification Details (as on 01.

and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank .3/3 Dheeraj Kumar Please retain your Registration No.