UNITED BANK OF INDIA - RECRUITMENT OF CLERKS

ONLINE APPLICATION FORM FOR THE POST OF CLERKS

20031

Registration # : 185303 Please paste your

recent passport size
photograph and sign
Full Name : Lokesh Kumar Agarwal across it.Please retain
atleast 5 copies with
you for subsequent
Category : General use.

Person With Disability : NO

Type of Disability : -- Percentage of Disability: --

Do you intend to use the services of a --

scribe(only for VI & OC candidates whose
writing speed is affected by cerebral
palsy)? :
Whether domiciled in Kashmir Division of NO
the State of J&K during the period
1-1-1980 to 31-12-1989 :
Belongs to Religious Minority Community : NO Minority Religion : --

Are you an Ex-Serviceman ? NO Are you Disabled NO

Ex-Serviceman (DISXS)?

Period of Service in the Defence forces (in -

months) :

Are you Dependent of an Ex-Serviceman NO

(DXS)? :

Are you seeking relaxation under widow NO

/divorced women / women judicially
Separated from their husbands and who
are not re-married? :
Nationality : Indian

State / Union Territory for which you are Rajasthan UT Centre code : 21
applying :

Centre of Examination : Jaipur Centre code : 51

Application Fee / Postal Charges Details

Transaction Id : M49629

Branch Name : Malviya Nagar

Branch Sol ID : 1440

Deposit Date : 10/09/10 Amount : 200

Personal Details :
Date of Birth : 14/11/1986 Age as on 01.07.2010 : 23

Gender : Male

Father’s Name : Govind Prasad Agarwal

Mother’s Name : Laxmi Devi Agarwal

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Marital Status : Single

Spouse Name(if Married) : --

Email ID : agarwal.lokesh86@gmail.com

Address for Correspondence : 7 Sachivalaya Vihar

New Sanganer Road Mansarover

Jaipur

District : Jaipur

State : RAJASTHAN Pin: 302020

Permanent Address: 7 Sachivalaya Vihar

New Sanganer Road Mansarover

Jaipur

District : Jaipur

State : RAJASTHAN Pin : 302020

Phone : 0141-2400087 Mobile : 9024932791

Qualification Details(as on 01.07.2010):

Exams Passed Subject / Stream University / Board Year Of Passing % of Marks
HSC / Equivalent : Science,Maths Rajasthan Board 2003 68.00
Graduation : BSc Rajasthan University 2006 74.00
Others : MCA Rajasthan Tech. Uni. 2009 72.57

Whether undergone Computer Course for YES

three months :

Other Details:
Whether desirous of taking Pre-Exam NO Centre for Training : --
Training (SC/ST/Ex-Servicemen/Religious
Minority Community) :

Languages Known Read Write Speak

Hindi YES YES YES
English YES YES YES

DECLARATION:
I hereby certify that the above information furnished is correct to the best of my knowledge and belief. I have not suppressed any material fact or
factual information in the above statement. I am aware that in case I have given wrong information or suppressed any material fact or factual
information or I do not satisfy the eligibility criteria according to the advertisement, then my candidature will be rejected/services terminated
even after permanent employment without giving any notice or reasons thereof.
I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of the advised criteria in respect of age, educational
qualification and experience etc.
I am also willing to serve anywhere in India. I agree that the Bank has the right to transfer me to any part of the country and/or to any job position
at its sole discretion in terms of applicable staff rules from time to time.
I hereby agree that any legal proceeding in respect of any matter or claims or disputes arising out of application or out of said advertisement can
be instituted by me only at Kolkata only, shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms
and conditions in the advertisement given by the Bank.

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Place : Signature of Applicant
Date : 10/09/10

Lokesh Kumar Agarwal

Please retain your Registration No. and Password emailed to you carefully for further reference.
NOTE: Please DO NOT SEND application print-out to the Bank

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