BANK OF INDIA - RECRUITMENT OF CLERKS

ONLINE APPLICATION FORM FOR THE POST OF CLERKS

18039
Registration # : 253251 Please paste your
recent passport size
photograph and sign
Registration Date and Time: 27-07-2010 18:55:52 across it.Please retain
atleast 5 copies with
you for subsequent
Full Name : Debashis Sarangi use.

Category : General

Person With Disability : No

Type of Disability : - Percentage of Disability : -

Do you intend to use the services of a scribe : -

Whether domiciled in Kashmir Division of the State of J&K during the No

period 1-1-1980 to 31-12-1989 :

Whether you belong to Religious Minority Community : No

Are you an Ex-Serviceman : No

Are you a dependent of an Ex-Serviceman (DXS)? : No

Are you seeking relaxation under widow / divorced women / women No

judicially Separated from their husbands and who are not re-married? :

Nationality : Indian

State / Union Territory for which you are Orissa State / UT code : 26
applying :

Centre of Examination : Bhubaneshwar Centre code : 2601

Application Fees / Postal Charges :

Transaction No. : M382645

Branch Name : Dhenkanal Branch Code No. : 5590

Deposit Date : 27-07-2010 Amount : 250

Personal Details :
Date of Birth : July 07,1987 Age as on 30.06.2010: 22

Gender : MALE

Husband’s Name / Father’s Name : Jayadev Sarangi Mother’s Name : Sudhira Padhi

Email ID : dsprincedev04@gmail.com

Address for Correspondence : At-Banamaliprasad Po-Mangalpur, Dist-Dhenkanal Pin-759015

State- Orissa

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District : Dhenkanal

State : ORISSA Pin : 759015

Permanent Address : At-Banamaliprasad Po-Mangalpur, Dist-Dhenkanal Pin-759015

State- Orissa

District : Dhenkanal

State : ORISSA Pin : 759015

Contact Details:
Phone : 06762-227103 Mobile : 9861433927

Qualification Details(as on 30.06.2010) :

Exams Passed Subject/Stream Year of Passing % of Marks Class / Grade
Matriculate : English,Oriya,scienc 2002 50.00 Second Class
HSC / Equivalent : Arts 2004 43.00 Pass Class
Graduation : Arts 2007 49.00 Second Class
Knowledge of Computers : Yes

Would You like to undergo Pre-Exam Training : No

Centre for Pre-Examination Training : -

Languages Known Read Write Speak

English Yes Yes Yes
Oriya Yes Yes Yes
Hindi Yes Yes Yes
DECLARATION:
I hereby certify that the information furnished above 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(s) or claims or disputes arising out of application or out of said advertisement
can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai 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.

Place : Signature of Applicant

Date : 27-07-2010

Debashis Sarangi
Please retain your Registration No., Password e-mailed to you and copy of print-out carefully for further reference.
NOTE: Please DO NOT SEND application print-out to the Bank

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