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Affix
NATIONAL BANK FOR AGRICULTURE AND RURAL
Signed
DEVELOPMENT Photograph
Here

CANDIDATE'S BIO-DATA-CUM-ATTESTATION FORM

:
Roll No. :

(Please fill in the form in your own

handwriting)

1 Name in full, in block letters as indicated in Degree Certificate with aliases, if any. Please also
indicate if you have added / dropped at any stage any part of your name / surname.
Shri/Smt./Kum. (Name) (First & Middle)

2 Father's / Husband's Name & Occupation

3 Category (Tick the appropriate box) :

SC ST OBC General PH Ex-M

4 Nationality : .................................................................................................
5 If you are a repatriate / migrant / displaced person, give particulars

6 : Date of Birth :

Date Month Year

7 Mother Tongue : .................................................
8 Knowledge of Languages other than English (Indicate by Tick Mark)
Language Can Speak Can Read Can Write Examination Passed, if any
 Educational Qualifications
Examination College/ Period Examining No. of Class & % of
Passed School Body Principal Attempts Rank Marks
From To Subjects Made

S.S.C.
Graduation

Post-
Graduation

Others (Specify)

9 Particulars of Prizes/Medals/ Scholarships

obtained
10 Particulars of Sports & Extra Curricular Activities, in which you have participated. Credits &
Distinctions Obtained

11 Particulars of any special

qualifications/training /experiences in
Banking

12 Particulars of Present & Previous Employment :

Name & Period Position & Place of Total Emoluments Reasons for
Address of Nature of Posting Leaving
the Employer From To Duties Starting Last Drawn

13 If the previous employment was under the Government of India or a State Government
/ an Autonomous Body / a University / a
Local Body

If you had left service on giving a months' notice under Rule 5 of the Central Civil
Services (Temporary Service) Rules,
1949 or any similar corresponding
Rules, were any disciplinary
proceedings framed against you, or Yes / No

had you been called upon to explain

your conduct in any matter at the time
you gave notice of termination of
service, or at a subsequent date before
your services actually terminated?

14 Please indicate your willingness to serve

anywhere in India
15 ................................ .............................. ............................
Place of Birth District State
16
District & State to which you belong

17 18
Marital Status : Married / Unmarried Religion :
Present Address for Communication in Full

:
Pin :
19
Residential Address in Full

:
Pin :
If originally a resident of Pakistan, the
Address in that Country & Date of Migration
to the Indian Union
20 Particulars of Places where you have resided
From To Residential Address in District Head Quarters of the Place
Full Mentioned in the Preceeding Column

21 Nationality of Father: Mother

Husband / Wife :
24 ............................. ....................... .......................
Place of Birth of Husband/Wife District State
25 Father's Present Postal Address (if Dead, give last address) and Permanent Residential Address
26 Father, in service, give Designation and

Official Address
27 Particulars of any Prosecution / Detention / Fine / Conviction / Sentence against you
Awarded by any Court of Law for any Offence
28 Particulars of any case pending against you
in any Court of Law at the time of filling up
this form
29 Particulars of disqualification / debarment by any Service Commission / Examining Body at
their Selection Examination
30 Particulars of any case of disciplinary action
instituted / pending against you by your
present or previous employer(s). Please also
state whether you were debarred from
appearing from any promotional examination
31 Particulars of Testimonials enclosed
32 Name and Address of Two References
Sr.No. Name Address

33 Additional Particulars, if any, which may be of use to the Bank

I certify that the particulars furnished above are true, correct and complete to the best of my
knowledge and belief, I am not aware of any circumstances which might impair my fitness
for employment under the Bank.
Date :
Place : Signature: