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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