IDBI Bank Limited

Human Resources
Mumbai400 005
Attestation Form

Warning
1.The furnishing of false information or suppression of any factual information in the Attestation Form would be
a disqualification and is likely to render the candidates unfit for employment in the Bank.
2.If detained, convicted, debarred, etc. subsequent to the completion and submission of this form, the details
should be communicated immediately to the Bank or the authority to whom the attestation from has been
sent earlier, the case may be, failing which it will be deemed to be a suppression of factual information.
3.If the fact that false information has been furnished or that there has been suppression of any factual
information in the attestation form comes to notice at any time during the service of a person, his services
would be liable to be terminated without any notice or compensation in lieu thereof.
Note: Please fill in the entire form in capital letters appropriately; write Not Applicable in the columns if
the entry is not applicable to you. If any column is left unfilled this form is considered incomplete and not
valid.

1. Name in full (in block capitals) with aliases, if any Affix you recent
Photograph and
(Please indicate if you have added or dropped at any stage any part of your name or surname.) sign across the
photograph
Surname K U M A R (6cm x 7cm)
First name V I P I N
Middle name

2. Present address in full (i.e. Village, Tehsil and District or House Number, Lane/Street/Road and Town).

Address 29 H A R I E N C L A V E

District B U L A N D S H A H R
State U T T A R P R A D E S H Pin 2 0 3 0 0 1
Telephone 9 4 5 1 2 6 4 6 1 5

3. (a) Home address/Permanent in full (i.e. Village, Tehsil and District or House Number, Lane/ Street/
Road and Town and name of District Head quarters.

Address 2 9 H A R I E N C L A V E

District B U L A N D S H A H R
State U T T A R P R A D E S H Pin 2 0 3 0 0 1
Telephone 9 4 5 1 2 6 4 6 1 5

(b) If originally a resident of Pakistan, the address in that country and the date of migration to Indian Union.
Address

N/A
District
State Pin
Telephone

Date of Migration (DD/MM/YYYY) :

Attestation Form -1-

4 Particulars of place (with periods of residence) where you have resided or more than one year at a
time during the preceding five years [Residential address in full (i.e. Village, Tehsil, & District Or House No.
Lane/State/Road &Town)]. In case of stay abroad (including Pakistan), particulars of all places where you
have resided for more than one year after attaining the age of 21 years should be given.
From:(DD/MM/YYYY) 0 1 0 4 2 0 1 3 From:(DD/MM/YYYY)
2 9 H A R I E N C L A V E
Address
District B U L A N D S H A H R
Name of District Headquarters B U L A N D S H A H R
State U T T A R P R A D E S H
PIN 2 0 3 0 0 1 Telephone No 9 4 5 1 2 6 4 6 1 5
From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No

From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No

From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No

From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No

5 (a) Name of Father (Name in full with aliases, if any) MANVIR SINGH
Nationality (by birth and/or by domicile) INDIAN
Place of Birth BULANDSHAHR

Occupation, if employed give designation & full official address: SR.GUARD INDIAN RAILWAY Office of Divisonal Railway Manager
Jhansi
Pin - 284003.

Present postal address 29 hari enclave chandpur road bulandshahr,UP 203001

(if deceased, give last address)
Permanent Home address
29 hari enclave chandpur road bulandshahr,UP 203001

(b) Name of Mother (Name in full with aliases, if any) NIRMALA SINGH
Nationality (by birth and/or by domicile) INDIAN
Place of Birth BULANDSHAHR
Occupation, if employed give designation & full official address: HOUSE MAKER

Present postal address 29 hari enclave chandpur road bulandshahr,UP 203001

(if deceased, give last address)
Permanent Home address
29 hari enclave chandpur road bulandshahr,UP 203001

Attestation Form -2-

 (c) Name of wife/husband (Name in full with aliases, if any) N/A

Nationality (by birth and/or by domicile) N/A

Place of Birth N/A

Occupation, if employed give designation & full official address: N/A

Present postal address N/A

(if deceased, give last address)
Permanent Home address N/A

6 Nationality INDIAN

7(a) Date of birth (DD/MM/YYYY) 2 0 0 7 1 9 9 1 7(b) Present Age 25 YEAR

7(c) Age of Matriculation 16 YEAR

8. (a) Place of birth, District and State in which situated BULANDSHAHR

(b) District and State to which you belong BULANDSHAHR , UTTAR PRADESH

(c) District and State to which your father originally belongs BULANDSHAHR , UTTAR PRADESH

9. (a) Your Religion HINDU

(b) Are you a member of a Scheduled Caste/ Scheduled Tribe? NO

Answer 'Yes' or 'No' and if the answer is 'Yes' state the name thereof.

10. Educational qualification showing places of education with years in Schools and Colleges since 15th year of age
Period
Name of School/College with full address Examination passed
Date of Joining Date of Leaving

ARMY SCHOOL,JHANSI APR 2005 MARCH 2006 10TH

KENDRIYA VIDYALAYA NO.3,JHANSI APR 2006 MARCH 2008 12TH

H.B.T.I. KANPUR AUG 2009 JULY 2013 B.TECH

11. (a) If you have, at any time, been employed give details : NO

Designation/Post Held Reason for leaving

Period (MM/YY) Full address of the firm or institution
or Job Description pervious service
From To

Attestation Form -3-

 11. (b) If the previous employment was under the
Government of India/s State Government an Undertaking NO
owned or controlled by the Govt. of India or a State
Government/an Autonomous Body/s University/s local
Body.
If you had left service on giving a month's notice under
rule 5 of the Central Civil Services' (Temporary Service) Rules,
1949, or any similar corresponding rules, were any disciplinary
proceedings framed against you, or had you had been called
upon to explain your conduct in respect of any matter at the
time you gave notice of termination of services, or at a
subsequent date, before your were services actually
terminated?

12. (a) Have you ever been arrested, prosecuted, kept under
detention or bound down/fined, convicted by a court of law for
any offence, or debarred/disqualified by any Public Service
Commission or any institution from appearing at its
examination/selection or debarred from any examination,
rusticated by any University or any other educational
Authority/institution?
(b) Is any case pending against you in any court of law,
University or any other educational authority/institution at the
time of filling up this attestation form?

(If the answer to (a) or (b) is 'Yes', full particulars of the case, arrest, detention, fine, conviction, sentence etc., and
the nature of the case pending in the Court/University/Educational authority etc., at any time of filing up this form
should be given.)

13. Name and addresses of two responsible persons of your locality or two references to whom you are known.

Name (in full) K A R T A R S I N G H

Address H A R I E N C L A V E

District B U L A N D S H A H R
State U T T A R P R A D E S H Pin 2 0 3 0 0 1
Telephone 9 4 5 2 5 9 7 9 8 1

Name (in full) M A H A B I R S I N G H

Address S U R Y A N A G A R

District B U L A N D S H A H R
State U T T A R P R A D E S H Pin 2 0 3 0 0 1
Telephone 9 9 1 0 9 1 0 3 6 9

I certify that the foregoing information is correct and complete to the best of my knowledge and belief. I am
not aware of any circumstances, which might impair my fitness for employment under Government/Bank.

Date : 14 APRIL 2017

Place : BULANDSHAHR

(Signature of candidate)

Attestation Form -4-

 Identity Certificate

Affix signed
passport
size
Photograph

Certified that I have known Shri/Shrimati/Kumari

son/daughter
VIIPIN KUMAR of
Shri. for the last years
.. months and that to the best of my knowledge and belief the
particulars furnished by him/her are correct.

Signature ..

Designation & Status & Address

..
..
..
(Rubber stamp of office)

Place: BULANDSHAHR
Date: APRIL 2017

P.S. The Photograph of the candidate to be attested by the competent authority.

Certificate to be signed by any one of the following: -

Gazetted Officers of Central or State Government;
Members of Parliament or State Legislature belonging to the Constituency where the candidate or his
parent/guardian is ordinarily resident;
Sub-Divisional Magistrates/Officers;
Tehsildars or Naib/Deputy Tehsildars authorised to exercise registrar(s) powers;
Principals and Head Masters of the recognised School/College/Institution where the candidate studied last;
Block Development Officers;
Post-Masters; and
Panchayat Inspectors.

TO BE FILLED BY THE OFFICE

Name, designation and address of the appointing authority: IDBI Bank Ltd.

Post of which the candidate is being considered. :

Attestation Form -5-