APPLICATION FOR ISSUE OF IDENTITY CARD

BRANCH / OFFICE:_______________
DATE : _______________
To

THE SECURITY DEPARTMENT

INDIAN BANK .............................. CO / ZO
...............................................................

(TO BE FILLED BY THE STAFF MEMBER IN CAPITAL LETTERS)

1. NAME (in English) :

(in Hindi) :
PHOTO
2. S R NO. :
(TO BE AFFIXED)
3. DESIGNATION :
4. DATE OF JOINING THE BANK :
5. DATE OF JOINING THE BRANCH :
6. LAST BRANCH / OFFICE SERVED :
7. REASON FOR REQUESTING NEW CARD (PLEASE TICK WHICHEVER IS APPLICABLE)
(A) NEW RECRUITMENT (E) OLD CARD (B) PROMOTION (DATE :____________)
(C) CARD LOST (D) ANY OTHER REASON

8. EMERGENCY CONTACT DETAILS:

(A) BLOOD GROUP :
(B) EMERGENCY CONTACT NO. :
(C) RESIDENTIAL ADDRESS : ..........................................................................................
: ..............................................................................................
(D) DATE OF BIRTH : ............................................
N.B.:
1. Old Identity Card and 01 Passport size colour photograph with name & SR No. written behind should be
enclosed along with the application. (Issue of new card upon loss of existing card will be guided by Circular
No. HRM/100/2007-08 dated 26.12.2007.

SIGNATURE OF THE OFFICER / STAFF MEMBER

(In Black ink, within the Box)
BRANCH MANAGER / DEPARTMENT HEAD RECOMMENDATION

DATE : SIGNATURE OF THE BM / DEPT. HEAD

BRANCH / OFFICE SEAL