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Andhra Bank Recruitment Project-2002

C/o Institute of Banking Personnel Selection,

Post Bag No.8591, Kandivali (East),

Mumbai 400101

With reference to your advertisement No. DatedI submit my application in the prescribed format.

1. Name (Mr./Mrs./Ms.).(in BLOCK LETTERS)

2. Maiden Name (in case of Married Women).

3. a) Correspondence Address .

...Pin .

b) Permanent Address .

.

..Pin .(For ease in Computer Processing, Name and Address should be filled using CAPITAL LETTERS IN

ENGLISH only)4. Choice of Centre for Written Examination.Centre Code No

5. Post Applied For ..Post Code No..

6. Additional post(s) applied for ..Post Code No..

7. Indicate Category to which you belong by marking X in the appropriate box.

SC ST OBC GEN

(Strike out whichever is not applicable)a) Are you an Ex-Serviceman? Yes No

b) Are you a candidate who had ordinarily been domiciledin Kashmir division of the state of Jammu and Kashmir Yes Noduring the period of 01.01.1980 to 31.12.1989?

c) Are you suffering from any orthopedic disorder(s)? Yes No

If you are an OH candidate please mention percentage of disability

d) Are you visually impaired? Yes No

8. a) Date of Birth (As per School Leaving Certificate/SSC) .

b) Age as on 01.01.2002 .9. Particulars of Demand Draft/Bank Pay Order

Name & Address

of the IssuingBank

Name & Address

of the DraweeBank Branch

Date of Issue Demand

Draft/Bank PayOrder No.

Amount

(Fees for the post: Rs.135/- [including postal charge] for General Candidate [including OBCs] andRs.35/- [postal charge] for SC/ST/OH/VH candidates)

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10. In case of SC/ST/OBC candidate

i) Name of the Caste ii) Name of the State to which you belong

11. Nationality

12. Place of Birth: TownDistrict..State..

13. Sex: Male Female

14. Fathers / Husbands Name.

15. Age relaxation claimed, if any:(Specify basis and enclose relevant certificates) YES NO

16. In case of Ex-Serviceman/Commissioned Officer/Police Officer/other equivalents, specify

i) Date of Discharge .ii) Rank at Present/last held a) Acting w.e.f

b) Substitute w.e.f17. a) Educational and Professional Qualifications (as on the date of application, Matriculation /SSLC

onwards to be supported by attested copies of the certificate. Do not enclose originals):

Examination

Passed

Name of the

Institution/

University

Subjects studied Date-Month-Year

of Passing

Percentage

of Agg. Marks

b) Computer Education

Examination

Passed

Name of the Institution/

University

Subjects studied Date-Month-Year of

Passing

c) Details of any other requirement ..

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18. Particulars of Post-Qualification Experience including the present occupation/job (as on the date ofapplication)

Name ofemployer(s)/firm,

etc. and the natureand details of

activities carried

out by the

employers

Designationand rank if

any

Period ofservice Length ofService Years /

Month / Days

Nature ofDuties

performed indetail

Remarks(Reasons

forleaving

services)

(Strike out whichever is not applicable)

19. a) I belong to SC/ST/OBC/Oh/VH category and I am enclosing an attested photocopy of the

prescribed certificate Yes No

DECLARATION

I here by declare that all statements made in this application are true, complete and correct to the best ofmy knowledge and belief. I understand that in the event of any information being found false or

incorrect at any stage or not satisfying the eligibility criteria according to requirements of the relative

advertisement, my candidature/appointment is liable to be canceled/terminated. I am willing to serveanywhere in India. I agree that bank has the right to transfer me to any part of the country at its

discretion. I hereby agree that any legal proceedings in respect of any matter(s) or claim(s) or dispute(s)arising out of this application and/or out of said advertisement can be instituted by me only atHyderabad and the Courts/Tribunal/Forums at Hyderabad 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 Nodatedof the Bank.

PLACE:DATE: SIGNATURE OF THE CANDIDATE