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Pragathi Gramin Bank Office Assistant - Multipurpose Written Examination Results
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(A Scheduled Bank owned by Government : Sponsored by Canara Bank)
Head Office : Post Box 55, Gandhinagar, Bellary - 583 103
Phone : (08392) 255853 Fax: 256886 e-mail: [email protected]
PERSONNEL WING : STAFF SECTION.
RECRUITMENT OF OFFICE ASSISTANT (MULTIPURPOSE)
WRITTEN EXAMINATION HELD ON 30.10.2011
LIST OF QUALIFIED CANDIDATES FOR INTERVIEW
We are pleased to announce the list of candidates qualified for interview in the written
examination held on 30.10.2011.
InterviewSlNo
Roll No Name
Date Time
1. 1101000013 AREKANTI MARESHU 22/12/2011 2.00 PM
2. 1101000020 MANOHAR ANNIGERI 22/12/2011 2.00 PM
3. 1101000021 MUCHI KRISHNA 22/12/2011 2.00 PM
4. 1101000136 G R VENKATESH 22/12/2011 2.00 PM
5. 1101000161 VISHWANATHA K 22/12/2011 2.00 PM
6. 1101000172 THEERTHA KUMAR C 22/12/2011 2.00 PM
7. 1101000255 LOKARAJA Y D 23/12/2011 9.30 AM
8. 1101000282 DEEPA S 23/12/2011 9.30 AM
9. 1101000308 SHIVAPPA HULAKOPPA 23/12/2011 9.30 AM
10. 1101000312 CHANDRAMOULY M K 23/12/2011 9.30 AM
11. 1101000317 SATISH KUMAR 23/12/2011 9.30 AM
12. 1101000336 MAHALAKSHMI 23/12/2011 9.30 AM
13. 1101000338 GAJENDRA B 23/12/2011 9.30 AM
14. 1101000350 MEENA TADIPATRI 23/12/2011 9.30 AM
15. 1101000356 MEENAKSHI G 23/12/2011 9.30 AM
16. 1101000390 PUSHPALATA ORIKOTI 23/12/2011 9.30 AM
17. 1101000409 BALU MAHENDRA NAIK R 23/12/2011 9.30 AM
18. 1101000421 SUNANDA K 23/12/2011 9.30 AM
19. 1101000439 D RAJESHWARI 23/12/2011 9.30 AM
20. 1101000469 JOHN BUDIGUMPI 23/12/2011 9.30 AM
21. 1101000472 SHARVANI K 23/12/2011 9.30 AM
22. 1101000493 GULLAMORUSU NAGENDRA 23/12/2011 9.30 AM
23. 1101000575 SEEMA G 23/12/2011 9.30 AM
24. 1103000589 RAMAVATH SRINIVASA NAIK 22/12/2011 9.30 AM
25. 1103000624 KIRAN KUMAR R N 22/12/2011 9.30 AM
26. 1103000633 VALMIKI PRAKASH 22/12/2011 9.30 AM
27. 1103000643 ROHIT K 22/12/2011 9.30 AM
28. 1103000673 ARUNA H B 22/12/2011 9.30 AM
InterviewSlNo
Roll No Name
Date Time
29. 1103000712 PHANEENDRA K 22/12/2011 9.30 AM
30. 1103000734 NIRMALA B 22/12/2011 9.30 AM
31. 1103000735 SHEKAR M 22/12/2011 9.30 AM
32. 1103000774 PRASHANTH J 22/12/2011 9.30 AM
33. 1103000804 RUDRESH V 22/12/2011 9.30 AM
34. 1103000812 DAYALA POTHALINGA 22/12/2011 9.30 AM
35. 1103000826 ANITHA R N 22/12/2011 9.30 AM
36. 1103000842 SAMRIN JAHA A 22/12/2011 9.30 AM
37. 1103000898 JAYALAKSHMI R 22/12/2011 9.30 AM
38. 1105000941 KOTRAIAH AM 19/12/2011 9.30AM
39. 1105001003 ARCHANA K 19/12/2011 9.30AM
40. 1105001009 ROOPA RANI K 19/12/2011 9.30AM
41. 1105001014 R NEERAJA 19/12/2011 9.30AM
42. 1105001018 K KUMARA SWAMY 19/12/2011 9.30AM
43. 1105001022 NAGARAKANIVI MANJULA 19/12/2011 9.30AM
44. 1105001024 SOUJANAYA VANIPRADHA 19/12/2011 9.30AM
45. 1105001093 S K TARUNA BAI 19/12/2011 9.30AM
46. 1105001115 VINOD SANGAPPA KUMBAR 19/12/2011 9.30AM
47. 1105001120 BOYA CHANDRAMOULI 19/12/2011 9.30AM
48. 1105001122 KAVITHA TULAJARAM SINGH 19/12/2011 9.30AM
49. 1105001128 ZABEEN KHANAM 19/12/2011 9.30AM
50. 1105001148 GOWDARA ROOPAVATHI 19/12/2011 9.30AM
51. 1105001172 M S ARUNA 19/12/2011 9.30AM
52. 1105001183 MANJULA K 19/12/2011 9.30AM
53. 1105001213 ANAND B 19/12/2011 2.00 PM
54. 1105001242 SHANKARAGOUDA 19/12/2011 2.00 PM
55. 1105001260 VIJAYA BHASKAR REDDY S 19/12/2011 2.00 PM
56. 1105001277 SHIVAKUMAR GOUDAR 19/12/2011 2.00 PM
57. 1105001284 GOVARDHANA A 19/12/2011 2.00 PM
58. 1105001290 ANUSHA RAJ P M 19/12/2011 2.00 PM
59. 1105001293 SAVITA TAMMANNAVAR 19/12/2011 2.00 PM
60. 1105001346 MANJUNATH T R 19/12/2011 2.00 PM
61. 1105001347 JAGADISH K 19/12/2011 2.00 PM
62. 1105001366 CHEEKATI RAGHAVA SURESH 19/12/2011 2.00 PM
63. 1105001391 KIRAN KUMAR 19/12/2011 2.00 PM
64. 1105001394 D VAMSHI MOHAN 19/12/2011 2.00 PM
65. 1105001420 NERANIKI CHINNA SHAIKSAB 19/12/2011 2.00 PM
66. 1105001437 ARUNA KUMAR B 19/12/2011 2.00 PM
67. 1105001486 MD AFZAL K 19/12/2011 2.00 PM
68. 1105001496 K VIRUPAKSHAPPA 19/12/2011 2.00 PM
69. 1105001518 SAI PRAVEENA LAKSHMI 19/12/2011 2.00 PM
70. 1105001521 PALEGARI RAJESWARI 19/12/2011 2.00 PM
InterviewSlNo
Roll No Name
Date Time
71. 1105001540 ARSHIYA NOUSHEEN 19/12/2011 2.00 PM
72. 1105001553 SHASHIDHAR HUNAGUNDI 19/12/2011 2.00 PM
73. 1105001564 B S GAYATHRI 20/12/2011 9.30AM
74. 1105001588 NIZAMUDDIN P 20/12/2011 9.30AM
75. 1105001589 SHARANABASAPPA SAJJAN 20/12/2011 9.30AM
76. 1105001629 PAVAN N C 20/12/2011 9.30AM
77. 1105001647 SRI BHARGAVI 20/12/2011 9.30AM
78. 1105001661 M VINOD KUMAR 20/12/2011 9.30AM
79. 1105001664 DODDANA GOUDA S 20/12/2011 9.30AM
80. 1105001737 MUNISHWARA A 20/12/2011 9.30AM
81. 1105001753 MAHESH REDDY K 20/12/2011 9.30AM
82. 1106002495 JAGADEESH KUMAR 20/12/2011 9.30AM
83. 1106002496 VIDYAVATI 20/12/2011 9.30AM
84. 1107001852 SUNNY KUMAR D 20/12/2011 9.30AM
85. 1107001859 G DHARANI 20/12/2011 9.30AM
86. 1107001860 VIKRAM Y 20/12/2011 9.30AM
87. 1107001882 K VIJAYASHREE 20/12/2011 9.30AM
88. 1107001899 B LAKSHMI 20/12/2011 9.30AM
89. 1107001927 VENKATESH A 20/12/2011 9.30AM
90. 1107001933 SREEHARI M 20/12/2011 9.30AM
91. 1107001943 YAMUNA ANANDI 20/12/2011 9.30AM
92. 1107001955 VENKATA SURESH K 20/12/2011 9.30AM
93. 1107001956 S B RAVINDRANATH 20/12/2011 2.00 PM
94. 1107001974 VINODKUMAR GOWDIPERU 20/12/2011 2.00 PM
95. 1107001977 CHANNABASAVA 20/12/2011 2.00 PM
96. 1107001985 K RAGHU RAMUDU 20/12/2011 2.00 PM
97. 1107001995 KAPU VENKAT RAMI REDDY 20/12/2011 2.00 PM
98. 1107002022 RANGA REDDY H 20/12/2011 2.00 PM
99. 1107002024 R RAGHAVENDRA 20/12/2011 2.00 PM
100. 1107002041 SAHANA S 20/12/2011 2.00 PM
101. 1107002071 G KALYANI 20/12/2011 2.00 PM
102. 1107002084 SHAM R K 20/12/2011 2.00 PM
103. 1107002106 Y MARUTHI PRASAD 20/12/2011 2.00 PM
104. 1107002113 K SHILPA 20/12/2011 2.00 PM
105. 1107002117 LINGAM KRISHNA REDDY 20/12/2011 2.00 PM
106. 1107002137 VEERESHAPPA 20/12/2011 2.00 PM
107. 1107002151 PAVAN KUMAR JOSHI 20/12/2011 2.00 PM
108. 1107002180 VIJAYA A 20/12/2011 2.00 PM
109. 1107002188 ANITHA B 20/12/2011 2.00 PM
110. 1107002212 ANITHA BAI A 20/12/2011 2.00 PM
111. 1107002223 L A SATISH KUMAR 20/12/2011 2.00 PM
112. 1107002242 RAKESH K R 20/12/2011 2.00 PM
InterviewSlNo
Roll No Name
Date Time
113. 1107002260 K SUDHAKARA REDDY 20/12/2011 2.00 PM
114. 1107002378 SARALA KUMARI KUDALI 21/12/2011 9.30AM
115. 1107002379 K N BHARADWAJ 21/12/2011 9.30AM
116. 1107002395 RAGHUNATH JAGADALA 21/12/2011 9.30AM
117. 1107002398 MANNE KIRAN KUMAR 21/12/2011 9.30AM
118. 1107002399 SHILPA A 21/12/2011 9.30AM
119. 1107002412 H VEENA 21/12/2011 9.30AM
120. 1107002432 ARCHANA VYAS 21/12/2011 9.30AM
121. 1201000027 PRIYANTH KUMAR H S 23/12/2011 9.30 AM
122. 1201000098 RAVI PRASAD G 23/12/2011 9.30 AM
123. 1201000107 LOKESH ARJUNNAVAR 23/12/2011 9.30 AM
124. 1201000178 ARJUN B 23/12/2011 2.00 PM
125. 1201000186 SANTHOSHA H 23/12/2011 2.00 PM
126. 1201000246 KANTHESWARA G 23/12/2011 2.00 PM
127. 1201000281 JAYACHANDRA A V 23/12/2011 2.00 PM
128. 1201000293 NISHANTH T R 23/12/2011 2.00 PM
129. 1201000331 GOWRI 23/12/2011 2.00 PM
130. 1201000343 SUNEEL BABU CHAVAN 23/12/2011 2.00 PM
131. 1201000353 RAVIKUMAR G 23/12/2011 2.00 PM
132. 1201000401 SHREEMANT BAJANTRI 23/12/2011 2.00 PM
133. 1201000422 SHANKARAPPA B 23/12/2011 2.00 PM
134. 1203000473 RAJESHWARI TEVARI 22/12/2011 9.30 AM
135. 1203000516 DEEPA C N 22/12/2011 9.30 AM
136. 1203000518 RAKESH S 22/12/2011 9.30 AM
137. 1203000531 ROHIT HANAMANT PARSHI 22/12/2011 9.30 AM
138. 1203000539 MALLIKARJUNA H 22/12/2011 9.30 AM
139. 1203000580 VEENA G N 22/12/2011 9.30 AM
140. 1203000590 SHASHI KUMARI K S 22/12/2011 2.00 PM
141. 1205000661 HANUMANT LADWA 21/12/2011 9.30AM
142. 1205000741 VINAYAK M DEVALKAR 21/12/2011 9.30AM
143. 1205000759 MANJUNATH RAMA NAIK 21/12/2011 9.30AM
144. 1205000795 VENKATA SUCHARITHA KARNAM 21/12/2011 9.30AM
145. 1205000818 CHANDRASHEKARA S R 21/12/2011 9.30AM
146. 1205000841 SANTHOSHKUMAR M L 21/12/2011 9.30AM
147. 1205000853 NAVEEN BABU D 21/12/2011 9.30AM
148. 1205000866 BHAGAVANTRAY MALI PATIL 21/12/2011 9.30AM
149. 1205000873 SHILPA YADAV K T 21/12/2011 9.30AM
150. 1205000888 SAMPATH ARAVIND TIRUMALE 21/12/2011 9.30AM
151. 1205000933 RAMAGONDA CHIPPARAGI 21/12/2011 9.30AM
152. 1205000946 SHIVARAJA R G 21/12/2011 9.30AM
153. 1207001027 CHANDRASHEKHAR SUDAMBI 21/12/2011 9.30AM
154. 1207001032 VIVEK B P 21/12/2011 9.30AM
InterviewSlNo
Roll No Name
Date Time
155. 1207001035 ANIL GARADALE 21/12/2011 2.00 PM
156. 1207001073 HIMANSHU B HEGDE 21/12/2011 2.00 PM
157. 1207001085 BANKIMCHANDRA ARUNKUMARMANNANGI
21/12/2011 2.00 PM
158. 1207001089 HEMAVATHI C BHURLI 21/12/2011 2.00 PM
159. 1207001090 VIJAYALAKSHMI BASAVARAJAPPAANGADI
21/12/2011 2.00 PM
160. 1207001109 SUBRAMANYA J 21/12/2011 2.00 PM
161. 1207001143 CHETAN DESHPANDE 21/12/2011 2.00 PM
162. 1207001154 DILEEP G R 21/12/2011 2.00 PM
163. 1207001186 NAGALINGAYYAPALANKAYYANAMATH
21/12/2011 2.00 PM
164. 1207001230 AREEFKHAN PATHAN 21/12/2011 2.00 PM
165. 1207001233 HARSHA R KULKARNI 21/12/2011 2.00 PM
166. 1207001244 VINOD K SAPLE 21/12/2011 2.00 PM
167. 1207001301 SATHISH SHIVALINGAPPA BIDI 21/12/2011 2.00 PM
168. 1207001309 RAVI JADIYAVAR 21/12/2011 2.00 PM
169. 1207001316 SHITHAL S KANGALGOUDA 21/12/2011 2.00 PM
170. 1207001341 PRASAD VASTRADMATH 21/12/2011 2.00 PM
171. 1207001363 SRINIVASA G K 21/12/2011 2.00 PM
172. 1207001390 SUHAS D 21/12/2011 2.00 PM
173. 1207001417 ANAND JOSHI 21/12/2011 2.00 PM
174. 1207001444 KONANAHALLI SIDDESHA 21/12/2011 2.00 PM
175. 1208001499 SWETHA K S 26/12/2011 2.00 PM
176. 1213001477 MANJUNATHA REDDY T V 26/12/2011 2.00 PM
177. 1301000042 SOWMYA N 23/12/2011 2.00 PM
178. 1301000074 BABU B TOTAD 23/12/2011 2.00 PM
179. 1301000081 VISHWANATHA B G 23/12/2011 2.00 PM
180. 1301000086 KALAVATHI K L 23/12/2011 2.00 PM
181. 1301000105 PRAMODRAJ K N 23/12/2011 2.00 PM
182. 1301000109 SARITHA C 23/12/2011 2.00 PM
183. 1301000126 BALU MAHENDRA S 23/12/2011 2.00 PM
184. 1301000137 MANJUNATH G 23/12/2011 2.00 PM
185. 1301000152 CHAITHRA R 23/12/2011 2.00 PM
186. 1301000155 PRADEEP KUMAR NAIK R 23/12/2011 2.00 PM
187. 1301000166 GIRI BABU 26/12/2011 9.30 AM
188. 1301000168 SHRIDHARA T M 26/12/2011 9.30 AM
189. 1301000171 SUMASHREE C 26/12/2011 9.30 AM
190. 1301000197 CHENNA KESHAVA MURTHY 26/12/2011 9.30 AM
191. 1301000212 SATHYA NARAYANA N 26/12/2011 9.30 AM
192. 1301000213 DHARMA PAL M 26/12/2011 9.30 AM
193. 1301000238 V LAVANYA 26/12/2011 9.30 AM
InterviewSlNo
Roll No Name
Date Time
194. 1303000240 MOHANKUMAR K V 22/12/2011 2.00 PM
195. 1303000243 DHANANJAYA SWAMY P S 22/12/2011 2.00 PM
196. 1303000247 JAYAPRAKASH P N 22/12/2011 2.00 PM
197. 1303000255 B VEENA 22/12/2011 2.00 PM
198. 1303000256 MALLESHA H S 22/12/2011 2.00 PM
199. 1303000257 B MANJUNATHA 22/12/2011 2.00 PM
200. 1303000273 DIVYA M 22/12/2011 2.00 PM
201. 1303000278 KALASHREE B G 22/12/2011 2.00 PM
202. 1303000286 AMRUTHA RAJNAL P 22/12/2011 2.00 PM
203. 1305000343 RAVI KIRANS 26/12/2011 2.00 PM
204. 1305000351 GANESH CHANDRAKANTHA BAGARE 26/12/2011 2.00 PM
205. 1305000362 SANJAYKUMAR A R 26/12/2011 2.00 PM
206. 1305000364 JAKKALA KARTHIK 26/12/2011 2.00 PM
207. 1305000367 PRADEEP M 26/12/2011 2.00 PM
208. 1305000370 MANJUNATHA B V 26/12/2011 2.00 PM
209. 1305000373 VENKATAREDDY D S 27/12/2011 9.30 AM
210. 1305000377 MANJUNATH SINGH B S 27/12/2011 9.30 AM
211. 1305000420 PRADEEP H Y 27/12/2011 9.30 AM
212. 1305000468 CHINNAPA BM 27/12/2011 9.30 AM
213. 1305000475 RAMESH H 27/12/2011 9.30 AM
214. 1305000485 P MOHAN KRISHNA 27/12/2011 9.30 AM
215. 1307000516 M S AKSHAY KUMAR 27/12/2011 9.30 AM
216. 1307000521 SREEDHAR L D 27/12/2011 9.30 AM
217. 1307000529 SUSHMA BS 27/12/2011 9.30 AM
218. 1307000543 ABHILASH G S 27/12/2011 9.30 AM
219. 1307000544 KURAKULA SREENIVASULU 27/12/2011 9.30 AM
220. 1307000577 MYTHILY G R 27/12/2011 9.30 AM
221. 1307000580 HEMALATHA V 27/12/2011 9.30 AM
222. 1307000582 MADAN MOHAN V 27/12/2011 9.30 AM
223. 1307000606 MANJUNATHA N 27/12/2011 9.30 AM
224. 1315000625 SHIVA SHANKER PRABHU ANEKAL 27/12/2011 9.30 AM
225. 1401000056 ARUN KUMAR 26/12/2011 9.30 AM
226. 1401000075 SHIVARAJ KUMAR 26/12/2011 9.30 AM
227. 1401000132 GODLA ERESHU 26/12/2011 9.30 AM
228. 1401000220 H PREMRAJ ODEYAR 26/12/2011 9.30 AM
229. 1401000278 PADMA 26/12/2011 9.30 AM
230. 1401000291 VINOD 26/12/2011 9.30 AM
231. 1401000325 PRAKASH LAXMAN RATHOD 26/12/2011 9.30 AM
232. 1401000336 UMADEVI G 26/12/2011 9.30 AM
233. 1401000340 AISHWARYA 26/12/2011 9.30 AM
234. 1401000409 ARUN 26/12/2011 9.30 AM
235. 1403000578 M CHINNA VEERESH 22/12/2011 2.00 PM
InterviewSlNo
Roll No Name
Date Time
236. 1404001274 NAGARAJA 22/12/2011 2.00 PM
237. 1405000635 SHILPA 27/12/2011 9.30 AM
238. 1405000661 MEENAKSHI SOLANKI 27/12/2011 9.30 AM
239. 1405000673 GANGADHAR KUMBAR 27/12/2011 9.30 AM
240. 1405000684 ARUNKUMAR 27/12/2011 9.30 AM
241. 1405000699 KHAJASAB 27/12/2011 2.00 PM
242. 1405000700 BAITINTI HEMANTHKUMAR 27/12/2011 2.00 PM
243. 1405000702 BHIMARAYA 27/12/2011 2.00 PM
244. 1405000716 MANJUNATH S SORAGANVI 27/12/2011 2.00 PM
245. 1405000718 AVINASH 27/12/2011 2.00 PM
246. 1405000721 MAHABAL CHIPPARAGI 27/12/2011 2.00 PM
247. 1405000728 ROOPA 27/12/2011 2.00 PM
248. 1405000746 ADIKI BALARAJU 27/12/2011 2.00 PM
249. 1405000747 SHANMUKHA 27/12/2011 2.00 PM
250. 1405000759 KOKILA P L 27/12/2011 2.00 PM
251. 1405000783 BASAVARAJ IRABASAPPA KUNTOJI 27/12/2011 2.00 PM
252. 1405000792 SHIVARAJ B L 27/12/2011 2.00 PM
253. 1405000805 ARUNAKSHI B PATTAR 27/12/2011 2.00 PM
254. 1405000826 KHAMITHKAR RAJESH 27/12/2011 2.00 PM
255. 1405000835 SABAAFREEN 27/12/2011 2.00 PM
256. 1405000857 ANJANEYULU KOTHA 27/12/2011 2.00 PM
257. 1405000869 JANGAM MALLIKARJUNA 27/12/2011 2.00 PM
258. 1405000910 MAHINDRA 27/12/2011 2.00 PM
259. 1405000939 ROOPA HARIKANT FIRANGI 27/12/2011 2.00 PM
260. 1405000951 VEERESH 27/12/2011 2.00 PM
261. 1405000957 SHAMSHUDDIN D 28/12/2011 9.30 AM
262. 1405000965 BASAVARAJ HATTARAKI 28/12/2011 9.30 AM
263. 1407001005 SHARANA BASAVA M PATIL 28/12/2011 9.30 AM
264. 1407001041 SUSHILKUMAR ULLEGADDI 28/12/2011 9.30 AM
265. 1407001042 AMARESH 28/12/2011 9.30 AM
266. 1407001048 NARAYAN 28/12/2011 9.30 AM
267. 1407001052 MADHURI M 28/12/2011 9.30 AM
268. 1407001057 VINAYAKUMAR SHETTAR 28/12/2011 9.30 AM
269. 1407001058 VIJAYAKUMAR 28/12/2011 9.30 AM
270. 1407001099 PAPPURI ROOPA 28/12/2011 9.30 AM
271. 1407001104 SHRI LAXMI 28/12/2011 9.30 AM
272. 1407001146 PRIYANKA RAGHAVENDRA PATHAK 28/12/2011 9.30 AM
273. 1407001183 CHANNABASAVA 28/12/2011 9.30 AM
274. 1407001188 SIDRAMAYYA 28/12/2011 9.30 AM
275. 1407001190 RAGHUVEER S NILUR 28/12/2011 9.30 AM
276. 1407001199 GURU PRASAD 28/12/2011 9.30 AM
277. 1407001200 BULLAPUR GAYATHRI 28/12/2011 9.30 AM
InterviewSlNo
Roll No Name
Date Time
278. 1407001227 GANGADHAR 28/12/2011 9.30 AM
279. 1407001231 KIRAN D RESHMI 28/12/2011 9.30 AM
280. 1407001239 VANDANA 28/12/2011 9.30 AM
281. 1407001259 S FARZANA 28/12/2011 2.00 PM
282. 1415001265 SONDURU MURALIDHARA RAO 28/12/2011 2.00 PM
283. 1501000035 CHANDRU K 26/12/2011 9.30 AM
284. 1501000037 PADMA N 26/12/2011 9.30 AM
285. 1501000051 CHETAN K H 26/12/2011 9.30 AM
286. 1501000053 SWATHI N 26/12/2011 2.00 PM
287. 1501000055 JAYARAJ KUMAR B S 26/12/2011 2.00 PM
288. 1501000069 PRAMOD H R 26/12/2011 2.00 PM
289. 1501000079 KRUPA SAGAR C 26/12/2011 2.00 PM
290. 1501000103 ARUNKUMAR H R 26/12/2011 2.00 PM
291. 1501000144 AKSHATHA M D 26/12/2011 2.00 PM
292. 1501000151 RAMPRASAD H G 26/12/2011 2.00 PM
293. 1501000162 MADHUSUDHAN H S 26/12/2011 2.00 PM
294. 1501000163 PRASHANTKUMAR L ALUR 26/12/2011 2.00 PM
295. 1501000173 PRAMOD ATOK 26/12/2011 2.00 PM
296. 1501000195 SRINIVASA R 26/12/2011 2.00 PM
297. 1501000225 GIRISH BP 26/12/2011 2.00 PM
298. 1503000290 VISHNU U C 22/12/2011 2.00 PM
299. 1503000309 GANESHKUMAR H V 22/12/2011 2.00 PM
300. 1505000330 SHWETHA S N 28/12/2011 2.00 PM
301. 1505000332 VARSHARANI SOORANAGI 28/12/2011 2.00 PM
302. 1505000472 D V KEERTHANA 28/12/2011 2.00 PM
303. 1505000485 HEMANTH RAJA D V 28/12/2011 2.00 PM
304. 1505000493 KUSUMA D S 28/12/2011 2.00 PM
305. 1505000550 MOHANA M 28/12/2011 2.00 PM
306. 1505000560 SUMA J 28/12/2011 2.00 PM
307. 1507000615 RAVINDRA PADIYAR 28/12/2011 2.00 PM
308. 1507000641 PRIYA P 28/12/2011 2.00 PM
309. 1507000658 MADHAVI M B 28/12/2011 2.00 PM
310. 1507000674 DEEPAK RAO C R 28/12/2011 2.00 PM
311. 1507000692 SANDESH K N 28/12/2011 2.00 PM
312. 1507000705 L SWETHA 28/12/2011 2.00 PM
313. 1507000711 CHETHAN M 28/12/2011 2.00 PM
314. 1507000757 MADHU KUMAR H K 28/12/2011 2.00 PM
315. 1507000769 KRUTHIKA A 28/12/2011 2.00 PM
316. 1507000770 NITHISH SA 28/12/2011 2.00 PM
317. 1507000790 ASHWINI BHAT H 28/12/2011 2.00 PM
318. 1507000801 GOUTHAM K R 29/12/2011 9.30 AM
319. 1507000828 AJITH NAYAK U 29/12/2011 9.30 AM
InterviewSlNo
Roll No Name
Date Time
320. 1507000856 SUCHITRA G S 29/12/2011 9.30 AM
321. 1507000859 MANJUNATH HEGDE 29/12/2011 9.30 AM
322. 1507000861 SANDEEP B G 29/12/2011 9.30 AM
323. 1507000877 MITHUN GK 29/12/2011 9.30 AM
324. 1507000881 GIRISH N 29/12/2011 9.30 AM
325. 1515000897 RAJENDRAN V 29/12/2011 9.30 AM
326. 1515000898 JAGADISH GANGAPPALAVAR 29/12/2011 9.30 AM
The interview is scheduled from 19.12.2011 to 28.12.2011 at Pragathi Gramin Bank,
Head Office, Bellary . Interview call letters have been despatched to the candidates
enlisted above. Those who do not receive the call letter well in advance may contact at
the following address:
The Chief Manager, Personnel Wing, Pragathi Gramin Bank, Head Office, 32,
Sanganakal Road, Gandhinagar, BELLARY 583 103 (Karnataka State)
Contact No: (08392) 255853, 258981, Fax: (08392) 256886.
email: [email protected]
Candidates are requested to bring the following while attending interview:
1. Bio-data form duly completed (1 original + 4 xerox copies), while attending the Interview.
Also note to bring originals and one set of attested true copies of the following certificates
/ documents in the same order.
a) Date of Birth certificate as entered in School record.b) Marks card / sheet from SSC / SSLC examination to the highest exam passed.
c) Certificate regarding Graduation, Post Graduation and other examination passed, if any.
d) Testimonials regarding proficiency in curricular / extra curricular activities, if any.e) Work experience certificate, duly specifying the date of joining, whether confirmed in the
services, salary drawn, nature of work handled, date of relieving and reasons for relieving
etc., from present / previous employer, if any.f) Caste / Community certificate issued by the competent authority in the case of SC / ST /
OBC category candidates in the prescribed format as per the proforma enclosed. Please
note that the caste mentioned in the certificate produced by you should tally letter by
letter to that of the caste as mentioned in the Central Government list / notification. OBCcertificate should be of issued on or after 01.04.2011. (if applicable)
g) If candidate belong to the category of “Persons With Disabilities”, you have to bring a
medical certificate in the revised format issued by the authorized Certifying Authority –i.e. Medical board appointed by the State Government at District levels comprising of
Chief Medical Officer / Sub-Divisional medical Officer in the District and an
Orthopaedic / Ophthalmic / ENT Surgeon.h) Service/discharge certificate issued by the Competent Authority in case of ex-
servicemen.
i) Print out of the online application submitted by you with your recent passport size
photograph affixed on it.
2. Please note that candidate shall not be allowed for the interview without the above mentionedcertificates / documents.
3. Please also bring the originals of :
a) No Objection Certificate from the present employer (applicable in the case of candidates
presently working).
b) Character Certificate from two respectable persons not related to you, obtained on arecent date.
4. The candidate has to appear for Interview at their own expenses. Only out station SC / ST /
Persons With Disabilities category candidates called for interview will be paid to and fro
II Class train fare or actual expenses incurred, whichever is less from normal place of
residence to the place of interview by shortest route, on production of proof of travel.
Please note that candidates who were found not eligible for the said post applied / do not
produce relevant certificates mentioned above shall neither be permitted to take the Interview,
nor shall be paid any traveling allowance. Any subsequent representation claiming TravelingAllowance shall not be entertained. Please also note that, the above concession will not be
admissible to the SC / ST / Persons With Disabilities category candidates who are
already in service in Central / State Government, Public Undertakings / Local
Government, Institutions and Panchayats.
5. Please note that candidate will be permitted to attend the Interview as mentioned above,
subject to;
i) Fulfillment of eligibility criteria / conditions regarding qualification, age, experience in
the relevant field etc, as stipulated in the advertisement; andii) Correctness of information given by candidate in application including
a) Caste / Community Certificate in the case of SC / ST / OBC category candidates; and
b) Medical Certificate in the case of Persons With Disabilities category candidates.
6. Please note that this is not an offer of appointment nor does it represent any commitment on
the part of the Bank to select candidate to any post in the Bank. The decision of the Bank in
all matters regarding Interview, selection of the candidates would be final and binding on thecandidates. No correspondence would be entertained in this regard.
7. Please bring call letter while appearing for the Interview.
The Bank will not entertain any request / correspondence for change of Date / Time / Venue of
the Interview.
Datewise candidates called for interview, formats of Bio-data, Caste Certificate and
Medical Certificate (for PWD candidates) enclosed
With best wishes.
Place : Bellary
Date : 08.12.2011 CHAIRMAN
Head Office, Post Box No.55, Gandhinagar, BELLARY 583 103
Phone: (08392) 255853, Fax 256886: email: [email protected]
Please affixhere a recentpassport size
photo and signacross it.
BIO-DATA FORM
[To be filled in by the candidate in his/her own handwriting and submitted in 5 copies (1 original + 4 xerox copies).Please read the instructions carefully before filling up this form]
Roll Number :
Post for which called for Interview : Post Code :
1 Name in full [In Block letters] :
2 Date of Birth and Age :
Day Month Year
Age :
3 Place of Birth :
4 Native Place : Taluk :
District : State :
5 Father’s / Husband’s Name :
6 Nationality : Religion :
Persons With DisabilitiesSC ST OBC GEN
OC HI VI7 Category :
[Please tick whichever isApplicable]
Permanent Address [in block letters] b] Communication Address [in block letters]
Pin : Pin :
Res :Res:Phone
Cell :Phone
Cell :
8 a]
E-mail : E-mail :
….Contd.Pg.2.
….Page.2….
9 Whether you are :
A] A member of Scheduled Caste : YES / NO,If YES, furnish sub-caste:
B] A member of Scheduled Tribe : YES / NO,If YES, furnish sub-caste:
C] A member of Other Backward Class : YES / NO,If YES, furnish sub-caste:
D] In case you belong to SC / ST / OBC category, indicate the serial number ofSub-caste as appearing in the Central Government list
:
E] An Ex-Servicemen / Disabled Ex-Servicemen : YES / NO
If YES, No. of years of service put in Defence Services, date of dischargewith reasons
:
F] Orthopaedically Disabled : YES / NOIf YES, furnish % of disability
G] Visually Disabled : YES / NOIf YES, furnish % of disability
H] Hearing Impaired : YES / NOIf YES, furnish % of disability
NOTE: Indicate whichever is applicable. A certificate in original from the Competent Authority should be produced inthe case of candidates belonging to Scheduled Castes, Scheduled Tribes and Other Backward Classes [asper the proforma enclosed]. OBC Certificate should be of issued on or after 01.04.2011. In the event ofconversion or re-conversion to Hindu or Sikh religion, adequate evidence including a copy of the relevantgazette notification and also other documentary evidence should be furnished. In the case of Ex-servicemen,Discharge Certificate issued by the concerned authority should be produced. In case of Persons WithDisabilities, sufficient documentary evidence including the medical certificate issued by the CompetentAuthority should be necessarily produced.
10 Whether attended Pre-examination training course, conducted by the Bank[applicable to SC/ST/MC category candidates]. If YES, please furnish thename of the centre.
:
11 Marital Status :[Single / Married / Widowed / Divorced / Legally Separated]
12 State the number of persons, who are dependent on you for support[Parents, Wife / Husband, Children, Brothers/Sisters, Others]
:
Name of dependent Age Relationship Occupation Income
Contd..3…
..3…
Educational Qualification[Full particulars from SSC / SSLC onwards to be given. If space is not sufficient furnish inannexure]
Certificate/Degree / Diploma
obtained
School / College /University / Board
PeriodFrom …To……
Principal & Optionalsubjects studied N
o.o
fatt
em
pts
Cla
ss &
Rank
obta
ined
Perc
enta
ge
of m
ark
sobta
ined
Prizes /Scholarship
s & otherdistinctionsobtained if
any
SSC
+2/ PUC
Graduation
P G
13
Others if any
14 Do you possess Computer Knowledge : YES / NO
If YES, Please mark the discipline
i] MS DOS / MS Windows :
ii]Basic concepts of Networking &Connectivity
:
iii] MS Office :
iv] Others [Furnish details] :
Work experience[Details of all previous employments, whether temporary or permanent including the presentemployment, if any, are to be given. If space is not sufficient furnish in annexure]
Period of EmploymentName andaddress of the
employer
Job title /Designation From To
Salary Job natureReasons
forleaving
15
Contd…4..
..4..
16 a] Mother Tounge :
To Speak :
To Read :b] Languages Known :
To Write :
17 Particulars of participation in Sports,Athletics, Scouts, NCC, Debates,Dramas or other Extra-Curricularactivities in School, College andelsewhere
:
18 Hobbies and other interests :
19 a] Have you ever been arrested, prosecuted, kept under detentionor bound down / fined / convicted by a Court of Law or whetherany case is pending against you in a Court of Law?If yes, give full details
:
b] Have you ever been debarred / disqualified by anyinstitution from appearing at its examination / selection ordebarred in any manner from any examination or rusticatedby any University or any other educational authority /Institution ? If yes, give full details
:
c] Is any case pending against you in any University or any othereducational authority / Institution at the time of filling up thisform? If yes, give full details
:
d] Has any case been filed against you at present or in the pastby any Bank, Insurance Company etc., for non-payment ofany loan taken from them ? If so, please give details
:
20 a] In case you are / were an employee of the Government/ PublicSector / Nationalized Bank/ Municipal Corpn.,/ Private SectorOrganization, please state whether there is any disciplinary casepending against you or whether any disciplinary case was takenagainst you during the last 3 years of your service. If so, pleasegive details
:
b] Were you ever removed, discharged/dismissed/made to resignfrom such service in the past? If so, please give details.
:
Please furnish Name, Occupation and address of TWO respectable persons, NOT relatedto you, to be given as reference
21
1] Name :Occupation :Address :
2] Name :Occupation :Address :
22 In case you are selected, how soon you can join :
Contd…5..
…5…
23 Additional information if any, which you wish to furnish :
The following are to be enclosed in the same order
A. CERTIFIED TRUE COPIES OF :
a) Date of Birth Certificate as entered in School record.b) List of marks from SSC / SSLC exam to the highest exam passed by you, including technical
and professional exams of each year / semester, if any.c) Certificate regarding graduation / post-graduation / other examinations passed.d) Testimonials regarding proficiency in Curricular/Extra-curricular activities, if any.e) Experience Certificate/s from the employer/s regarding present and previous employment.f) Caste certificate issued by the Competent Authority in the prescribed format as per the
proforma enclosed in the case of SC/ST/OBC candidates.g) Service / Discharge certificate issued by the Competent Authority in the case of Ex-
servicemen.h) Medical certificate from the authorized Certifying Authority – i.e., Medical Board appointed by
the State Govt. at District levels comprising of Chief Medical Officer / Sub-Divisional MedicalOfficer/s in the District and an Orthopaedic / Opthalmologist / ENT Surgeon as the case maybe, in the case of candidates belonging to Persons With Disabilities category.
B. ORIGINAL CERTIFICATES /DOCUMENTS:
1. No Objection Certificate from the employer in the case of candidates working.2. Character certificate from two respectable persons not related to you, obtained on a recent
date.3. Caste Certificate issued by the Competent Authority.4. Printout of online application submitted with recent passport size photograph affixed on it.
I ____________________________________________ hereby declare that the abovestatements are true, complete and correct and also that no facts have been suppressed. It isunderstood that employment, if any, offered to me is based upon the truthfulness of thestatements made herein and in the event of any information being found false or incorrect at alater date, my appointment is liable to be terminated. I further state that, if selected, I am willingto be posted to any of the branch/office of the Bank.
DATE :
PLACE : SIGNATURE OF THE CANDIDATE
FOR OFFICE USECertificates Scrutinized by:
Name :
Designation :
Office Address :
Date :Signature
FORM OF CERTIFICATE TO BE PRODUCED BY ACANDIDATE BELONGING TO SCHEDULED CASTE ORSCHEDULED TRIBE IN SUPPORT OF HIS / HER CLAIM.
(Form of Certificate as prescribed in MHA., O.M No. 42/21/49-N.G.S, dated 28.01.1952 as revised inDept. of Per. & A.R. Letter No. 36012/6/76-Estt.(S.C.T), dated 29.10.1977, to be produced by a candidatebelonging to a Schedules Caste or Scheduled Tribe in support of the claim)
1.This is to certify that Sri*/Smt*/Kum*-_______________________________________________ son*/ daughter*of______________________________________________________ of village*/ town*____________________________ in District*/ Division*_______________________of theState*/ Union Territory*__________________belongs to the__________________________Caste*/Tribe* which is recognized as a Scheduled Caste*/ Scheduled Tribe*
under :
The Constitution ( Scheduled Castes) Order, 1950 ;
* The Constitution ( Scheduled Tribes) Order, 1950 ;
* The Constitution (Scheduled Castes)(Union Territories)Orders, 1951 ;
* The Constitution (Scheduled Tribes)(Union Territories)Order, 1951 ;
[as amended by the Scheduled Castes and Scheduled Tribes lists (Modification Order),1956,the Bombay Reorganisation Act, 1960, the Punjab Reorganisation Act 1966, the State ofHimachal Pradesh Act, 1970, the North-Eastern Areas (Reorganisation)Act, 1971,and theScheduled Castes and Scheduled Tribes Orders (Amendment) Act,1976]:
* The Constitution (Jammu and Kashmir) Scheduled Castes Order,1956 ;
* The Constitution (Andaman and Nicobar Islands) Scheduled
Tribes Order, 1959 as amended by the Scheduled Castes and Scheduled
Tribes Orders (Amendment) Act, 1976 ;
* The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962 ;* The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962 ;* The Constitution (Pondicherry) Scheduled Castes Order 1964;* The Constitution (Uttar Pradesh) Scheduled Tribes Order,1967;* The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968 ;* The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968 ;* The Constitution (Nagaland) Scheduled Tribes Order, 1970 ;* The Constitution (Sikkim) Scheduled Castes Order, 1978 ;* The Constitution (Sikkim) Scheduled Tribes Order, 1978 ;* The Constitution (Jammu and Kashmir) Scheduled Tribes Order, 1989 ;* The Constitution (Scheduled Castes) Orders (Amendment)Act, 1990;* The Constitution (Scheduled Tribes) Orders (Amendment) Ordinance, 1991 ;* The Constitution (Scheduled Tribes) Orders (Second Amendment) Act,1991 ;* The Constitution (Scheduled Tribes) Orders (Amendment) Ordinance, 1996.
………2
:: 2 ::
2** This certificate is issued on the basis of the Scheduled Castes*/ Scheduled Tribes*
Certificate issued to Shri*/ Smt* / Kumari*
_________________________________________ Father* /Mother* of Sri*/Smt*/
Kumari*_______________________________________________of
village*/town*______________________in District*/Division*____________________of the
State*/Union Territory*____________________________________________ who belong to
the______________________ Caste*/ Tribe* which is recognized as a Scheduled
Caste*/Scheduled Tribe* in the State*/Union Territory* issued by the
____________________________________ dated _______________________.
3.Shri*/Smt*/Kumari*___________________________________________and/or* his*/her*
family ordinarily reside(s) in village*/town*__________________________
of____________________ Disctict*/ Division* of the State*/ Union Territory* of
_____________________
Signature _____________________
Designation ___________________
Place : [With seal of Office]Date : State/Union Terriroty
Note : The term "Ordinarily resides" used here will have the same meaning as in Section 20 ofthe Representation of the Peoples Act, 1950.---------------------------------------------------------------------------------------------------------------------------------------* Please delete the words which are not applicable.**Applicable in the case of SCs, STs persons who have migrated from one State/UnionTerritory.
List of authorities empowered to issue Caste / Tribe Certificates :
1. District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner /Additional Deputy Commissioner / Deputy Collector/I Class Stipendiary Magistrate / Sub-Divisional Magistrate / Extra-Asst.Commissioner / Taluka Magistrate / Executive Magistrate.
2. Chief Presidency Magistrate/ Additional Chief Presidency Magistrate / presidency Magistrate.3. Revenue Officer not below the rank of Tehsildar.4. Sub-Divisional Officers of the area where the candidate and / or his family normally resides.
-- -- --
FORM OF CERTIFICATE TO BE PRODUCED BYOTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT
TO POSTS UNDER THE GOVERNMENT OF INDIA(G.I.Dept of Per & Trg. O.M.No.36033/28/94-Estt (Res), dated 2-7-1997)
This is to certify that_____________________________________________Son/Daughter
of______________________________ of _______________________________
village/Town of ______________________District/Division in
___________________________ State belongs to
______________________________community which is recognized as a Backward Class
under:
[i] Resolution No.12011/68/93-BCC[C], dated the 10th September, 1993, published in theGazette of India, Extraordinary, Part-I, Section-1 No.186, dated the 13th September 1993.
[ii] Resolution No.12011/9/94- BCC [C], dated the 19th October, 1994, published in theGazette of India, Extraordinary, Part-I, Section-1 No.163 dated the20th October 1994.
[iii] Resolution No. 12011/7/95-BCC [C], dated the 24th May 1995, published in the Gazetteof India, Extraordinary, Part-I, Section-I No.88, dated the 25th May 1995.
[iv] Resolution No.12011 / 96 / 94 - BCC, dated 9th March 1996. [v] Resolution No.12011/44/96- BCC[C], dated the 6th December 1996, published in the
Gazette of India, Extraordinary Part-I, Section-1 No.210, dated the 11th December 1996. [vi] Resolution No.12011 / 13 / 97 - BCC, dated 3rd December 1997. [vii] Resolution No.12011/99/94-BCC, dated 11th December 1997. [viii] Resolution No.12011/68 /98-BCC, dated 27th October 1999. [ix] Resolution No.12011/88/98-BCC, dated 6th December 1999 published in the gazette of
India. Extraordinary Part-I, Section-I, No.270, dated 6th December, 1999. [x] Resolution No.12011/36/99-BCC, dated 4th April 2000, published in the Gazette of India.
Extraordinary Part-I, Section-I, No.71, dated 4th April, 2000. [xi] Resolution No.12011/44/99-BCC, dated 21-9-2000, published in the Gazette of India,
Extraordinary Part-I, Section-I, No.210 dated 21-9-2000.
Sri__________________________ and/or his family ordinarily reside[s] in the
_______________ District/Division of the________________ State. This is also to certify
that he/she does not belong to the persons /sections [Creamy Layer] mentioned in
column 3 of the Schedule to the Government of India, Department of Personnel &
Training OM No.36012/22/93- Estt.[SCT], dated 8-9-1993.
Dated : District Magistrate orSeal : Deputy Commissioner, etc
………….2
:: 2 ::
NB: (a) The term "Ordinarily" used here will have the same meaning as in Section 20 of theRepresentation of the Peoples Act, 1950.
(b) The authorities competent to issue Caste certificates are indicated below:
i] District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / AdditionalDeputy Commissioner / Deputy Collector / First Class Stipendiary Magistrate / Sub-DivisionalMagistrate / Taluka Magistrate / Executive Magistrate / Extra Asstt. Commissioner [not belowthe rank of First Class stipendiary Magistrate].
ii] Chief Presidency Magistrate / Additional Chief Presidency Magistrate / PresidencyMagistrate.
iii] Revenue Officer not below the rank of Tehsildar;
iv] Sub-Divisional Officer of the area where the candidate and/or his family resides.
-- -- --
DECLARATION BY THE CANDIDATE SEEKING RESERVATION AS OBC
“I, _______________________________________________________ Son/daughter of Shri
_____________________________________________________________ resident of
village/town/city ______________________ district___________________ state
___________________ hereby declare that I belong to the ______________________
community which is recognised as a backward class by the Government of India for the purpose
of reservation in services as per orders contained in Department of Personnel and Training Office
Memorandum No. 36012/22/93-Estt (SCT), dated 08.09.1993. It is also declared that I do not
belong to persons/sections (Creamy Layer) mentioned in column 3 of the Schedule to the above
referred Office Memorandum, dated 08.09.1993.”
Place :
Date : (Signature )
DISABILITY CERTIFICATE
Annexure-1 to O.M. dated 29.12.2005
Name and address of the Institute/Hospital:
Certificate No : Date:
1. This is to certified that Sri/Smt/Kum __________________________ Son/Wife/daughter of
Sri __________________________________ age _______ Sex _______identification
mark(s) ______________________________________________________________
_____________________________________________________________________is
suffering from permanent disability of following category:
A. Locomotor or cerebral palsy:
i. BL – Both legs affected but not arms.
ii. BA – Both arms affected (a) Impaired reach.
(b) Weakness of grip
iii. BLA – Both legs and both arms affected.
iv. OL – One leg affected (right to left) (a) Impaired reach.
(b) Weakness of grip.
(c) Ataxic
v. OA – One arm affected (a) Impaired reach.
(b) Weakness of grip.
(c) Ataxic.
vi. BH- Stiff back and hips (Cannot sit or stoop).
vii. Mw – Muscular weakness and limited physical endurance.
Recent Phtograph of
the candidate showing
the disability duly
attested by the
Chairperson of the
Medical Board.
..2..
B. Blindness of low vision:
i. B-Blind.
ii. PB – Partially Blind.
C. Hearing impairment:
i. D-Deaf.
ii. PD – Partially Deaf.
(Delete the category whichever is not applicable).
2. This condition is progressive/non-progressive/likely to improve/ not like to improve. Re-
assessment of this case is not recommended/ is recommended after period of _____ years
_______ months. (Strike out which is not applicable)
3. Percentage of Disability in his/case is _____ percent.
4. Shri/Smt/Kum ________________________________________________ meets the
following physical requirements for discharge of his/her duties.
i. F- can perform the work manipulating with fingers. Yes/No.
ii. PP- can perform the work by pulling and pushing. Yes/No.
iii. L- can perform the work by lifting Yes/No.
iv. KC- can perform the work by kneeling and crouching Yes/No.
v. B- can perform work by bending. Yes/No
vi. S- can perform work by sitting. Yes/No
vii. ST- can perform work by standing. Yes/No
viii. W- can perform work by walking Yes/No
ix. SE- can perform work by seeing. Yes/No
x. H- can perform work by hearing/speaking Yes/No
xi. RW- can perform work by reading and writing Yes/No
(Dr________________________) (Dr_______________________)
Member Member
Medical Board Medical Board
(Dr________________________)
Member
Medical Board
Countersigned by
Medical Superintendent/CMO/Hc Hospital with seal
* Strike out which is not applicable.
