DECLARATION OF FAMILY MEMEBERS/CLOSE RELATIVES EMPLOYED AND PRIOR EMPLOYMENT WITH

CSB BANK LIMITED

1. I hereby declare that as of date, none of my family member/s or close relatives; such as below are
employed with Csb Bank Limited or it’ s associate or group concerns or with the agencies
associated with Csb Bank Limited:

Father Wife Sister’s husband Step Son

Mother Husband Brother’s wife Step Daughter

Son Brother in-law Husband of wife’s sister Step Brother

Daughter Sister in-law Wife of brother in-law, Step Sister

Brother Father in-law Brother’s son or daughter Step Mother

Sister Mother in-law Sister’s son or daughter Step Father

Father’s Sister Father’s Brother Son’s Son Grand Children

Mother’s Sister Mother’s Brother Son’s Daughter Step Grand Children

2. I hereby undertake to informtothe Human Resources Department and senior management of Csb
Bank Limitedin writing under acknowledgment or by email,if and whenanyof the persons falling in
the above categories offamily member/s or close relative/s, takesup any employment with Csb
Bank Limited, any time in future. I hereby undertake to immediately inform to my higher authorities
and the Human Resources Department, as stated above, within 10 days of such employment

3. I also undertake to inform to the above stated authorities about any of the family member/s or close
relative/s who are already employed with Csb Bank Limited for the time being becoming or
deemed to have become my family member/s or close relative/s, by virtue of marriage/birth etc.

4.I hereby declare that I was never employed in Csb Bank Limited, any time earlier.

Yes/No

(If Answer is Yes, please give the information as below)

I hereby declare that I was earlier employed with Csb Bank Limited, the tenure and the
role/location thereof is given herein.

From To ECN No and Department/ Reason for leaving

dd/mm/yy dd/mm/yy designation Branch/Business

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I hereby declare that if any of the contents of this declaration is found to be false or distorted or if I
fail to adhere to the terms of this undertaking, I will be liable for disciplinary action leading to
punishment or termination without any notice depending upon the discretion of the authority.

Signature:
Name of the candidate:
Date:
Place:

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