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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 Naresh OBC 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 : M386117 anna nagar 2644 09-02-2011 200 india Tamil Nadu 34 CHENNAI 31 chennai sriperumbudur thiruvallur NO NO

Personal Details :

I have not suppressed any material fact or factual information in the above statement.2/3 Date of Birth : Gender : Father's Name/ Husband's Name : Mother's Name : Email ID : Address for Correspondence : March 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 am aware.2011.1986 MALE 11/1 Santham Colony Anna Nagar West Chennai-600101 District State : Pin : Permanent Address : Chennai TAMILNADU 600101 11/1 Santham Colony Anna Nagar West Chennai-600101 District State : Pin : Chennai TAMILNADU 600101 Age as on on 01.r padmavathy.01. 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.45 69. : 24 Contact Details: Phone No : Mobile No: Qualification Details (as on 01. in case. educational qualification and experience. I am also willing to serve anywhere in India.01. I have given wrong information or suppressed any material fact or factual information or.2011): 044-26151854 9094262667 Exams Passed HSC / Equivalent : Graduation : Diploma in Banking : Possess certificate in computer literacy : Subject/Stream commerce mca University / Board state board madras university NO YES Year Of Passing 20-04-2004 10-06-2010 % of Marks 74.76 Post qualification work experience details as on 01. I do not satisfy the eligibility criteria according to the advertisement.d dnareshmail@gmail. . that.01. etc. then my candidature will be rejected/services terminated even after permanent employment without giving any notice or reasons thereof.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 Tamil Telugu YES YES NO Write YES YES NO Speak YES YES YES DECLARATION: I hereby certify that the information furnished above is correct to the best of my knowledge and belief.

Place: Date: 09-02-2011 Signature of Applicant Naresh Please retain your Registration No.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. shall have sole and exclusive jurisdiction to try any cause/dispute. 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 .