15038

To,
Post Box No. 27662
Malad- (East)
Mumbai 400 097
Registration #: 15153 Please paste your
Full Name : CHANDRAKUMARA B SANNAMARADI recent passport
size photograph
Post Applied For OFFICE ASSISTANTS and sign across it.
Post Code 1 Please retain
atleast 5 copies
Category OBC with you for
If Physically Challenged: NO subsequent use.
Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989 : NO
Whether you belong to Religious Minority Community? : NO
Are you an Ex-Serviceman? : NO
Are you a Disabled Ex-Serviceman (DISXS)?: NO
Are you a Dependent of an Ex-Serviceman (DXS)? : NO
Are you seeking relaxation under window / divorced women / women judicially Separated from their
NO
husbands and who are not re-married?:
Nationality: INDIAN
Center of Examination : DHARWAD Center Code : 11
Application Fee/ Postal Charges Details:-
Name of Issuing Bank : SBI
Place of Issue : PUNYASTAL
Demand Draft/Pay Order No. 844440
Date of Issue : 31/12/2010
Amount : 200
Personal Details:
Date Of Birth : 16/07/1986
Age completed as on 01.09.2010 : 24
Gender : MALE
Husbands / Fathers Name: BASAVANTHAPPA
Mothers Name: NEELAMMA
Address for Correspondence: P W D IRRIGATION COLONY
AT POST-BASAVAPATTAN
TALLUK-CHANNAGIRI
District DAVANAGERE
State: KARNATAKA Pincode: 577551
Permanent Address: P W D IRRIGATION COLONY
AT POST-BASAVAPATTAN
TALLUK-CHANNAGIRI
District DAVANAGERE
State: KARNATAKA Pincode: 577551
Contact Details:
Mobile No: 9538662117
E-mail ID: cbsannamaradi@yahoo.co.in
Qualification Details(as on 30.09.2010):
Exams Passed Subjects/Streams Year Of Passing % Of Marks Class / Grade
Graduation : B A HIST KAN(OPT.) SOCI 2009 62.90 FIRST CLASS
Working Knowledge of Computers: YES
Details of Computer Knowledge : BASIC KNOW
Post Qualification work experience details (Start from present Employer) :
Name of the
Nature of Reason
Employer & Designation Years of
Total Period of Service duties for
Nature of and Rank Service(YY/MM)
performed Leaving
Employment
From To
Other Details:
Would You like to undergo Pre-Exam Training (SC/ST): NO

Languages Known Read Write Speak

KANNADA YES YES YES
ENGLISH YES YES YES
HINDI 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 etc.

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 Raipur and courts/ Tribunal/ forums at Raipur 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: 08/01/2011 Signature of Applicant:

CHANDRAKUMARA B
SANNAMARADI