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Recruitment of Officer JMG Sc-I,Officer MMG Sc-II and Office Assistants (Multipurpose)

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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 # : Full Name : Post : Post Code : Category : If Physically Challenged : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe (only for VI & OC candidates whose writing speed is affected by cerebral palsy) :

1007203 Vishal Kumar Officer (JMG) Scale-I 02 GENERAL NO NA

Are you candidate who had ordinarily been domiciled in Kashmir Division of the State NO 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/Commissioned Officers(Including ECOs/SSCOs) : Actual Period of service rendered in defence services as an Ex-serviceman (in months) : Are you seeking relaxation under widow / divorced women / women judicially Separated from their husbands and who are not re-married : Nationality : Centre of Examination : Centre code : Application Fee / Postal Charges Details : Payment In: Transaction ID : Branch Name : Branch Code No : Date of Deposit : Amount : Punjab National Bank M414774 Jahu 222200 23-01-2012 500 NO Indian MANDI 11 NO -NO

Personal Details : Date of Birth : Age completed as on 01-11-2011 : Gender : Father's Name / Husband's Name : 01-09-1984 27 MALE Sh. Brij Lal

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Mother's name : Address for Correspondence : Smt. Sheela Devi Vill- Bari P.O- Smaila Teh- Sarkaghat District : State : Pin : Permanent Address : Mandi HIMACHAL PRADESH 175034 Vill- Bari P.O- Smaila Teh- Sarkaghat District : State : Pin : Contact Details: Email ID : Phone Number : Mobile Number : Qualification Details (as on 01.11.2011): Exam Passed Graduation/Equivalent : Post Graduation : Working Knowledge of Computers : Details of Computer Knowledge: Post Qualification work experience details (Start from present Employer): Name of the Employer Designation From(mm/yyyy) To(mm/yyyy) Nature of Duties Performed Reason for Leaving Length of Service (YY/MM) Name of the Course/Degree Science Management Year of Passing 2004 2011 YES MS Office % of Marks 50.58 63.03 Class / Grade Second Class First Class vishalshrma60@gmail.com 8091492116 Mandi HIMACHAL PRADESH 175034

Total Experience (in months) : Other Details : Whether desirous of taking Pre-Exam Training -(Only for SC/ST/Minority/EXS) : If Yes Centre for Training : -Languages Known Hindi English Read YES YES Write YES YES

Speak 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

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instituted by me only at Mandi and courts/ Tribunal/ forums at Mandi 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: 08-02-2012 Signature of Applicant

Vishal Kumar

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