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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 : Category : If Person with Disability : Type of Disability : Do you intend to use the services of a scribe( only for VH and OH candidates whose writing speed is affected by cerebral palsy) : Are you 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? Are you Children/family members of those who died in 1984 riots Whether you belong to Religious Minority Community Minority Religion : Are you an Ex-Serviceman (Including ECO/SSCO)? Are you a disabled Ex-Serviceman (DISXS) Are you a dependent of an Ex-Serviceman (DXS)

Mr Rathod Indrajit Jivabhai GENERAL NO --NO NO NO -NO NO NO Percentage of Disability : --

Have you passed in Service (Departmental) Examination which is equivalent NO to Civil Examination not below the rank of HSC? Are you seeking relaxation under widow/divorced women/women judicially/ Separated from their husbands and who are not re-married? District Preference for Posting : District Preference 1 : District Preference 2 : District Preference 3 : Are you an employee of Bank of Baroda : If yes,E. C. No : 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 No : Deposit Date : Amount : M306539 Naroda Road 0851 07-02-2011 200 Nationality Gujarat 20 AHMEDABAD 11 Ahmedabad Ahmedabad Ahmedabad NO NO

Personal Details :

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.01. 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 am aware.01.1984 MALE Jivabhai Manabhai Rathod Madhuben Jivabhai Rathod dipak_105@yahoo. : 26 Contact Details: Phone No : Mobile No: Qualification Details (as on 01.00 Post qualification work experience details as on 01.83 40.2011 (Start from Present Employer) : No Experience Other Details : Whether desirous of taking Pre-Exam Training (SC/ST/PWD/Minority Community) : If Yes Centre for Training : --- Languages Known Read English Hindi Gujarati YES YES YES Write YES YES YES Speak YES YES YES DECLARATION: I hereby certify that the information furnished above is correct to the best of my knowledge and belief.01. I have not suppressed any material fact or factual information in the above statement. educational qualification and 079-22818789 9586472979 Exams Passed HSC / Equivalent : Graduation : Diploma in Banking : Possess certificate in computer literacy : Subject/Stream Commerce B com University / Board GHSEB Guj University NO YES Year Of Passing 18-03-2001 24-04-2006 % of Marks 44. . that.2/3 Date of Birth : Gender : Father's Name/ Husband's Name : Mother's Name : Email ID : Address for Correspondence : May 02. I have given wrong information or suppressed any material fact or factual information or. in case. I am also willing to serve anywhere in India. I do not satisfy the eligibility criteria according to the advertisement. then my candidature will be rejected/services terminated even after permanent employment without giving any notice or reasons 132 Sarjan Bunglows Nr Parshwanath Township Krishnanagar New Naroda Ahmedabad District State : Pin : Permanent Address : Ahmedabad GUJARAT 382346 132 Sarjan Bunglows Nr Parshwanath Township Krishnanagar New Naroda Ahmedabad District State : Pin : Ahmedabad GUJARAT 382346 Age as on on 01. etc.

3/3 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. Place: Date: 07-02-2011 Signature of Applicant Rathod Indrajit Jivabhai Please retain your Registration No. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank . shall have sole and exclusive jurisdiction to try any cause/dispute.