8/14/2019 Officer Application Form

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APPLICATION FORMAT

(Fill up all columns in legible capital letters and mark in appropriate box/es)(SEALED ENVELOPES SUPERSCRIBED PUNJAB & SIND BANK OFFICERS RECRUITMENT PROJECT 2010-11

BE ADDRESSED TO AS UNDER).

To

PO Box No.

_____________Mumbai_______

With reference to your advertisement No.______________in Employment News/Rozgar Samachar dated

___________________, I submit my application in the prescribed format.

1. FULL NAME IN BLOCK LETTERS: (Leave one space blank between two parts of your names)

Mr. / Ms.

2. ADDRESS FOR CORRESPONDENCE (IN BLOCK LETTERS)

PINCODE

3. Contact No./ Phone No. ( with STD code)

Mobile No E-Mail ID

4. CENTRE OF EXAMINATION _________________________ CODE :

(IN BLOCK LETTERS)

5. POST APPLIED ________________________ CODE :

6. CATEGORY TO WHICH BELONG : SC ST OBC GEN

Indicate by mark in appropriate box. (Please enclose photocopy of certificate.)

7. If Physically challenged , please indicateOC HI VI

( Please enclose certificate issued by Medical Board at District level specifying type of handicap andpercentage of disability).

8. (a). DATE OF BIRTH ( As per school leaving certificate SSLC/SSC)DD MM YY

(b). AGE (As on 01.01.2010):______ Years_______Months________Days.

Relaxation in age (if claimed) : No. of Years____________Under category__________

Please affix yourrecent colouredpassport sizephotograph and

sign across.

Please retain fivecopies of thesame forsubsequent use.

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9. DETAILS OF APPLICATION/POSTAGE FEE:

APPLICATION FEE FOR EACH POST INCLUDING POSTAL CHARGES (NON REFUNDABLE) :

Details of Application fees:

Name and

address of theissuing Bank

Name and address of

the drawee Bank

Date of Issue DD/Bank

pay orderNo.

Amount

(Rs.)

[Fee for the post is Rs. 400/- for General/OBC/EX-SERVICEMEN Candidates (including postage) andRs. 50/- (postage only) for SC/ST/Persons with Disability (PC) candidates]. Payment by Cash, Cheque

Postal Stamps, Money Order, etc. will not be accepted and such applications will be rejected.

Note :

i.) Application fee including postage should be paid by a single Demand Draft / Pay Order payable to

Punjab & Sind Bank A/c for each post separately to be drawn as below PUNJAB & SIND BANK Recruitment Project-2010 Specialist Officers payable at Mumbai

PUNJAB & SIND BANK Recruitment Project-2010 Probationary Officers payable at Mumbai

ii.) Candidate must write his/ her name, date of birth & address on the reverse side of the Bank Draft/

Bankers Cheque.

iii.) Payment of postage charges / Application Fee by Cash / Cheques / Money Orders etc. will not beaccepted.

iv.) Bank Draft or Bankers cheque / postal order, must be purchased on or after the date ofadvertisement but on or before the last date of receipt of application.

v.) Payment by any other mode will not be accepted.

vi.) Candidates applying for more than one post should submit separate application for each post alongwith requisite fees.

vii.) Application once made will not be allowed to be withdrawn and postage charges once paid will notbe refunded on any account nor can it be held in reserve for any other selection process.

viii.) Applications should be accompanied with copies of relevant certificates/testimonials duly attested by aGazetted Officer.

10. To be filled in only by those SC/ST/Minority Community candidates, who are desirous of taking

Pre Exam Training (Applicable only for Probationary Officers).

(i) WOULD YOU LIKE TO UNDERGO PRE-EXAM TRAINING: YES NO

indicate by mark in appropriate box.(ii) IF YES , CHOICE OF CENTRE FOR PRE-EXAM TRAINING: _____________

11. INDICATE BY MARK IN APPROPRIATE BOX :

(i) GENDER: MALE FEMALE

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(ii) a) Are you Ex-serviceman ? : YES NO

b) In case of Ex-serviceman/Commissioned Officer/Police Officer/Other equivalents. Specify

1. Date of Discharge : ____________________________________

2. Rank at present /last held A ) Acting _________w.e.f._________B) Substantive __________w.e.f._____

(iii) Are you a candidate who is ordinarily being domiciled in Kashmir Division of State of Jammu &

Kashmir during the period 01.01.1980 to 31.12.1989YES NO

(If yes, enclose a copy of certificate issued by the Competent Authority.)

(iv) Whether you belong to Minority Community? YES NO

If yes, please state the religion: ________________________________

(v)Incase of SC/ST/OBC Candidate(i) Name of the Caste/Tribe/Class :____________________________

(ii) Name of the State to which you belong : _____________________

12. FATHER'S / HUSBANDS NAME ( IN BLOCK LETTERS):

13. NATIONALITY: _____________________

14. PLACE OF BIRTH: Place__________Distt.___________State ___________

15. PERMANENT ADDRESS:

PINCODE 16. EDUCATIONAL AND PROFESSIONAL QUALIFICATION (From 10th Standard Onwards, as

on 01.01.2010). (please enclose Xerox copies of mark sheet and certificates):

Examination passed Name of the Board/

Institution/University

Subjects studied in

detail

Month & Year of

Passing

%age of

Marks

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17. PARTICULARS OF POST-QUALIFICATION EXPERIENCE

(As on 01.01.2010).

Name of Employer &Nature of activitiescarried out by them

Designation Length of service

Years Month

Nature ofduties performed

Remarks(Reason forleaving service)

Period of service

From To

18.LANGUAGES KNOWN:

(Read) (Write) (Speak)

________ ________ _________

________ ________ _________________ ________ _________

19. ANY OTHER INFORMATION

BEFORE MAILING APPLICATION PLEASE CHECK THAT YOU HAVE CORRECTLY MENTIONED.

i) The post code & post name, you have applied for.ii) The Centre where you wish to appear at.iii) Category / sub-category and have enclosed copies of necessary certificates for SC/ST/OBC/PH

Candidates.

iv) Details regarding fees (Demand Draft / Pay Order).v) Address for Correspondence.vi) Details for claiming relaxation in age and you have enclosed the relevant certificate.

________________________________________________________________________________DECLARATION

I hereby declare that all the statements made in this application are true, complete and correct to the best of my

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 the requirements of the relative advertisement, mycandidature / appointment is liable to be cancelled / terminated. I have not been debarred from taking up the test

/ selection by any bank/CRB/BSRBs/IBPS and I have not been convicted in any criminal case. I am willing to

serve any where in India, if selected.

I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of this

application and / or out of said advertisement can be instituted by me only at New Delhi and Courts/Tribunals/

Forums at New Delhi only shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake toabide by all terms & conditions mentioned in the advertisement given by the bank with regard to this

recruitment.

PLACE: _______________ DATE: _______________ SIGNATURE OF APPLICANT