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ON-LINE APPLICATION FOR ANDHRA BANK CLERKS RECRUITMENT PROJECT

26037
Please paste your recent passport size photograph and sign across it. Please retain atleast 5 copies of same photograph with you for subsequent use.

Registration # : Full Name : Category : If Person with Disability : Type of Disability : Do you intend to use the services of a scribe( only for VI and OC candidates whose writing speed is affected by cerebral palsy) : Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989? Whether you belong to Religious Minority Community Religion to which you belong : Are you an Ex-Serviceman? Are you a disabled Ex-Serviceman (DISXS) Are you a dependent of an Ex-Serviceman (DXS) Are you Children / family members of those who died in 1984 riots ?: Are you seeking relaxation under window / divorced women / women judicially Separated from their husbands and who are not re-married? Are you an employee of Andhra Bank : If yes, Staff Code No: Nationality : State / Union Territory for which you are applying : State / UT code : Centre of Examination : Centre code : Application Fee / Postal Charges Details : Payment in : Transaction ID : Branch Name : Branch SOL ID : Deposit Date : Amount :

3033188
N Ravi Kalyan SC NO --NO NO -NO NO NO NO NO NO Percentage of Disability : --

Indian Tamil Nadu 01 Chennai 51

Andhra Bank Branch 203049 Saligramam 1077 04-02-2011 75

Personal Details :
Date of Birth : Gender : Father's Name/ Husband's Name : Mother's Name : 03-08-1979 MALE P Nageswara Rao P Vanajakshi Age as on on 31.12.2010. : 31

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Email ID : Address for Correspondence : ravikalyan1979@gmail.com P-150 M.M.D.A Colony Arumbakkam District State : Pin : Permanent Address : Chennai TAMILNADU 600106 P-150 M.M.D.A Colony Arumbakkam District State : Pin : Chennai TAMILNADU 600106

Contact Details:
Phone No : Mobile No: Qualification Details (as on 31.12.2010) : 044-42076306 9840632103

Exams Passed
Graduation : Knowledge of Computers : Details of Computer Knowledge : Other Details :

Subject/Stream
BBA YES MS Office

Year Of Passing
March/2005

% of Marks
40.00

Whether desirous of taking Pre-Exam Training (SC/ST/Minority Community) : If Yes Centre for Training :

YES Tirupathi

Languages Known Read

Telugu English Tamil Hindi NO YES YES YES

Write
NO YES YES YES

Speak
YES 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/ service 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 advised criteria in respect of age, caste, 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 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 Hyderabad and courts/ Tribunal/ forums at Hyderabad only, shall have sole and exclusive jurisdiction to any cause/ dispute. I undertake to abide by all the terms and conditions in the advertisement given by the Bank.

Place: Date: 04-02-2011 Signature of Applicant

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N Ravi Kalyan

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