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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 # : 265131
Category : OBC
If Person with Disability : NO

Type of Disability : -- Percentage 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? : NO
Minority Religion : --
Are you an Ex-Serviceman? NO
Are you Children/family members of those who died in 1984 ? : NO

Are you an employee of Andhra Bank : NO
If yes, Staff Code No:
Nationality : INDIAN
Centre of Examination : Vishakapatnam
Centre code : 28

Application Fee / Postal Charges Details :
Payment in : Andhra Bank Branch
Transaction ID : 192865

Branch SOL ID : 0106

Deposit Date : 18-02-2011
Amount : 400

Personal Details :
Age completed as on
Date of Birth : May 1987,15 23
31.12.2010 :
Gender : MALE

Father's Name/ Husband's Name : SIMHACHALAM

Mother's Name : ANNAPURNA
Email ID :

Address for Correspondence : SIMHACHALAM


2010): Exams Passed Subject/Stream Year Of Passing % of Marks Graduation : BSC March-2007 62.C++ Other Details : Whether you like to undergo Pre-Exam Training (SC/ST /Minority -- Community): If Yes .31 Post Graduation / Equivalent : MCA March-2011 72.12. 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. caste. Place: Date: 20-02-2011 Signature of Applicant RAMUNAIDU DARAPUREDDI Please retain your Registration No. I have not suppressed any material fact or factual information in the above statement.Centre for Training : -- Languages Known Read Write Speak ENGLISH YES YES YES TELUGU YES YES YES DECLARATION: I hereby certify that the above information furnished is correct to the best of my knowledge and belief. shall have sole and exclusive jurisdiction to any cause/ dispute. educational qualification and experience etc.00 Knowledge of Computers : YES Details of Computer Knowledge : C. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank . I am also willing to serve anywhere in India. I undertake to abide by all the terms and conditions in the advertisement given by the Bank. then my candidature will be rejected/ service terminated even after permanent employment without giving any notice or reasons thereof. 2/2 State : ANDHRA PRADESH Pin : 535546 Permanent Address : SIMHACHALAM THAMARAKHANDI(PO) SEETHANAGARAM(MD) District VIZIANAGARAM State : ANDHRA PRADESH Pin : 535546 Contact Details: Phone No : - Mobile No: 9492928994 Qualification Details (as on 31. 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. I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of advised criteria in respect of age. 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.