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P lease paste y our recent passport size photograph and sign across it. P lease retain atleast 5 copies of same photograph w ith y ou 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) Have you passed in Service (Departmental) Examination which is equivalent 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 :

Mr SINGH BIPIN KUMAR GENERAL NO --NO NO NO -NO NO NO NO NO Percentage of Disability : --



M152549 CSKPUR 3254 10-02-2011 200

Personal Details :
Date of Birth : Gender : Father's Name/ Husband's Name : Mother's Name : July 12,1989 MALE VIJAY SINGH BANDANA DEVI Age as on on 01.01.2011. : 21



shall have sole and exclusive jurisdiction to try any cause/dispute. 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.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 English HINDI ORIYA Read YES YES NO Writ e 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…/registration_print. I am also willing to serve anywhere in India.01. in C/O. I am aware.44 Post qualification work experience details as on 01.01.12 CSPUR BHUBANESWAR District State : Pin : Permanent Address : KHURDA ORISSA 751024 C/O. I do not satisfy the eligibility criteria according to the advertisement. I have given wrong information or suppressed any material fact or factual information or. educational qualification and experience.12 CSPUR BHUBANESWAR District State : Pin : KHURDA ORISSA 751024 Contact Details: Phone No : Mobile No: Qualification Details (as on 01. 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.bipin55@yahoo. I have not suppressed any material fact or factual information in the above statement.B. Place: Date: 10-02-2011 Signature of Applicant SINGH BIPIN KUMAR Please retain your Registration No.2011): 9778697525 Exams Passed HSC / Equivalent : Diploma in Banking : Possess certificate in computer literacy : Subject/Stream SCIENCE University / Board CBSE NO YES Year Of Passing 26-05-2007 % of Marks 74. BISWAL NILADRI VIHAR SECTOR 4 PLOT NO . then my candidature will be rejected/services terminated even after permanent employment without giving any notice or reasons thereof.php 2/2 .10-02-2011 Email ID : Address for Correspondence : Welcome to BANK OF BARODA singh. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank. etc. that. 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. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank …sifyitest. BISWAL NILADRI VIHAR SECTOR 4 PLOT NO .B.