wa wee ure de Madhya Pradesh Gramin Bank (A joint ventare of Got. of india, Bank of India and MUP Govt.) erat char wearer Gaga aerRat_/RBa ) & ue ux Palas ag far ferries 14.12.2020 ner we uy ae, germ orate, ge waadl car wheat a Pegler Cadel & oma ox a WAT (Retired Bank nati RBA vet & fore wa /ara afta @ srtes—wa aaa oe 2) seep alts ders faite orl Hh eT Go oer Fa wer afta we fe Prater vt we fale 23122020 7H afraria: wre et ond, feria 23.12.2019 & are wre eA aa odes wall we fea wef fear Sree Feary iy waa werd or avis / forte safe /aReatre atere waa p de 8 steed 3) 1 wat mens F waa | aqea dae o1 a & fe ser | sider wa warhiget) Great flail Concurrent Audit | #Y org, fore siren cutters | fer art | er 2, were dear her} sare | 08 TH AR Ta aT Retired ao ma oT ra eters [em eet a Bank | wa er Aur | Zeek ad oh ea Peat art at amma | | (apa) | | fee gr: onder eer et | | | {i saa we a mr | onde AR ae afte | xen agen aia) | a oye Heed Office: Second Foy, Arcade Siva New 6 Sees Now Paci (WP) sH0 Emal-njgbhoindore@yahoo.com, in Prone: 731 264S05ubute fax Tat DAGDS0, ol Feo 18002896205Ager o a fer em ed seer a a8 eh | SER aftaat /RBA ) ot ori flea sad aE es Sets | aiden el ae wrth vei & fay ones va eat daufe 8 ure fey or wad & wh wr aR oer eH wert orafea ge A fai 23.12.2020 ae war fey oT & one ata } ae waa oe Ty ardaat wt aftr weno & fae wa to S ger orate % gerar org| que ale wy fe mea wee aor dar fear feet gd 3 ge far ote ot a ator exer war 8) fertie:— 14.12.2020 [wea ax fe oR ue oof we oar & | | | | | Head Office: Segond Foy, Arcade Siva New 9 Shas Now Fala er (WP) <0 Emal-njgbhoindore@ya bse : www. mpgb.in Phone: 0734 284S08u/su6s, Fax O78 B4seute Toll Pree No 1800258 6295Annexure 4 Engagement of Retired Officials of Madhya Pradesh Gramin Bank for Concurent Audit Work BIO-DATA CUM APPLICATION FORMAT The application should be accompanied with latest address proof, PAN Card copy, Copy of Pension Pass Book, Self-attested by the applicant ‘SNo._[ PARTICULARS DETAILS O1_| NAME OF THE APPLICANT (02 [EMP NO. (03___| PRESEN F ADDRESS OF THE APPLICANT (04 | LANDLINE NOS (WITH STD CODE) AND MOBILE NOS 05 EMAIL ADDRESS a (06__| DATE OF BIRTH i et (07 [AGE AS ON DATE (MONTH YEARS) | | (08 | QUALIFICATION ACADEMIC | (9 | QUALIFICATION PROFESSTONAT. | 10 | ANY OTHER QUALIFICATION re Tl [DATE OF PROMOTION TO OFFICERS CADRE, 12 [DATE OF SUPERANNUATION, VOLUNTARY RETIREMENT 13 NAME OF THE BRANCH / OFFICE & Region LAST WORKFD | Ig [ACCOUNT NUMBER WITH IFSC DETAILS 13 [TOTAL SERVICE UN YEARS) _ | 16 DESIGNATION AT THE TIME OF RETIREMENT | 17 BRANCH EXPERIENCE (IN YEARS) 1g [ EXPERIENCE AS BRANCH HEAD iF ANY (IN YEARS) 19 | WORKING EXPERIENCE IN CHARGE OF CREDIT Branch— DEPARTMENT IN A BRANCH IF ANY (IN YEARS) No. of Years — | 20__| WORKING EXPERIENCE AS IN CHARGE OF CREDIT RO/HO! ] DEPARTMENT IN RO/HO! Designation ~ | IF ANY (IN YEARS) No. of Years — | | | pa WORKING EXPERIENCE AS IN INSPECTION 1 DEPARTMENT IN BANK IF ANY (IN YEARS) FIELD/ADMINISTRATION [22] WHETHER SUFFERING FROM ANY MAJOR ALMENT OR I HAS UNDERGONE ANY MAJOR SURGERY | 23__| WHETHER ANY MINOR MAJOR PENALTY foe | 24 | PROCEEDING WERE INITIATED DURING 5 YEARS PRIOR | TO RETIREMENT. (Y/N) oa 35 | WHETHER INVOLVED IN ANY CBT CASES, | DETAILS THEREOF. J Head Office: Second Foo: Arcade Siver, Nea 66 Shops, New Paladi,Indoro (MP) 462003 Email njghhoindore@yahoo.com, Wobsits: werw moat Phone: 0731-2548083/54/5, Fax 0731-2422432, Toll Free No, 1600 233 6205| S.No._| PARTICULARS = e DETAILS 6 | PREFERENCE OF BRANCHES, BASE BRANCH) HEAD QUARTERS ADDITIONAL PREFERENCE 1 a | 3. 27 | PLACE OF DOMICILE 28 DETAILS | Name of Office | ion OF LAST | Design FIVE Period POSTINGS From To- | confirm that the details/information furnished above are / is true and correct. In ease, any of the details furnished above is found to be incorrect at a later date, The Bank has right to terminate the assignment given, without giving any notice. Place : Date: For Office Use Signature of the applicant Head Office: Second Floor Arcade Svar, Near 6 Snops, New Palani Emal-njgbhoing Website: wor Phone: 0731 com, indore (AP) 48200 Tobe, Pac rat teeta Tol Faw 18002096285