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Central Bank of India Clerical Recruitment Project � 2010

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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 # : 677260
Full Name : SAMUDRALA ANUSHA RANI
Category : SC
Whether person with disability : NO
Type of Disability : - Percentage of Disability : --
Do you intend to use the services
of a scribe (only for VH & OH
--
candidates whose writing speed is
affected by cerebral palsy)? :
Are you a candidate who had ordinarily
been domiciled in Kashmir Division
NO
of the State of J & K during the
period 1-1-1980 to 31-12-1989 ? :
Whether you belong to Religious Minority Community? NO
Religion to which you belong :
Are you an Ex-Serviceman ? NO
If Ex-Serviceman, have you
passed in Service (Departmental)
Examination which is recognized NO
as equivalent to Civil Examination b
not below the level of Matriculation?:
Are you a Disabled Ex-Serviceman (DISXS)? : NO
Period of Service in the Defence force (in months) :

Are you a Dependent of an Ex-Serviceman (DXS)? : NO

Whether children / family members of those
NO
who died in 1984 riots ? :

Are you seeking relaxation under

window / divorced women / women judicially
NO
Separated from their husbands and
who are not re-married? :
Nationality : INDIAN HINDU

State / Union Territory for which you are applying : Andhra Pradesh

State / UT code : 01
Centre of Examination : Hyderabad

Centre code : 11

Application Fee / Postal Charges Details :

Transaction ID : 623813
Branch Name : ONGOLE BRANCH

Branch Code : 0840

Deposit Date : 08-12-2010 Amount : 50

Personal Details :
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Age completed as on
Date of Birth : June 10,1989 21
01.11.2010. :
Gender : FEMALE

Father's Name/ Husband's Name : NARASIMHA RAO

Mother's Name : RAJESWARI

Address for Correspondence : VIJAYA TAKIES ROAD

28TH BLOCK LADLA KASAMMA BAZAAR

MARKAPUR

District PRAKASAM
State : ANDHRA PRADESH Pin : 523316

Permanent Address : VIJAYA TAKIES ROAD

28TH BLOCK LADLA KASAMMA BAZAAR

MARKAPUR
District PRAKASAM

State : ANDHRA PRADESH Pin : 523316

Contact Details:
Phone No : - Mobile No : 9493591386
Email ID : naniveena250@gmail.com

Qualification Details (as on 01.11.2010)::

Exams Passed Subject/Stream Year Of Passing % of Marks Class / Grade

SSC / Equivalent : MATHS 2004 64.10 First Class

HSC / Equivalent : BI.P.C 2008 52.70 Second Class

Knowledge of Computer : YES

Diploma in Banking : NO

Languages Known Read Write Speak

English YES YES YES

TELUGU YES YES YES

Other Details :
Would You like to undergo Pre-Exam Training (SC/ST/Religious Minority
YES
Community/PC/Ex-Serviceman) :
If Yes Centre for Training : Hyderabad

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 this 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 mentioned in the advertisement given by the Bank.

Place:
Date: 08-12-2010 Signature of Applicant
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SAMUDRALA ANUSHA RANI
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