RESUN{E

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Father's Name
Age & Date of Birth
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Sex

Nationality
Marital Status
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Cr:tnmunication Addrcss laf .P' . pis, Sal"$,v-
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Cottact numbers (Mobile
number1,2,3..)
3:o3tsoj$fr Contact nurnber (Res)

Previous experience NH
A DR-A Reg. Number DRA Status
p Driving License +4All Ration card Number
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p numbcr oo I (q1o Iz* r'r-
t Passport number e Voter id nr.rmbcr
I Bank Ac. no 6 -Bank Name '+17 -(
c
Educational Qualifi cation
a PAN Card number ,VqFB SLLV A (Last Cornpleted)
n B.A
t Other KYC Other KYC Document
d Documcnt(lf any) (lf anv) -number
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o Emergency Contact Emergency Contact
c Narne & Relationship Nurnber
u Blood Group
m I hereby grant my consent and authorize the Bank to conduct periodical credit
€ Credibility check informafion checks with credit inlbrmation companies and other suitable
n consent trackground checks (including any criminal background check, character, and
t antecedent verification).
d 1. Is there any close relative working for any other Collection I Sates/Credit
a agency of the bank? (Yes I No)_ .If yes Please furnish the staff name, vendor
t name and department catered
a
I Conflict of interest
2.I conlirm and declare that I have not / will aot gift or provide hospitality of
I any rnonetary value or any other benefits / gratuities to any Bank employee to
s obtain or maintain my service contract.

R Name of tl.re Referencc Relationship Organization name" Addrcss, I)esignation Contact number
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Declaration: I hereby declare that the above said particulars are true to the best of my knowledge.

I)ate: r -4 - Zo \2-- Y faithtully,

Place: ,7r"h"
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(Applicant Narne & Signature)