APPLICATION FORM

For admission in
Advanced Diploma in Banking Technology-IV (2010)

Registration No.:
Affix Photo
(To be allocated by the Institute) Sign across the
1. Personal Details photo in a way that
part Signature
1.i. Name: Mr / Ms_________________________________ come on photo and
(In capital letters) part on the paper

(as it appears in your Degree / High School Certificate)

1.ii. Date of Birth (dd / mm / yyyy)____________________
1.iii. Nationality ______________________________
1.iv. Category SC ST OBC General
1.v. Father’s Name ____________________________
1.vi. Address for Communication ______________________
___________________________________________
____________________________________________
City______________ Pin Code ___________
1.vii. Phone (with STD Code) __________________________
1.viii. Mobile No. ______________________________________
1.ix. E-mail __________________________________
Parents/Guardians’ information

1.x. Name __________________________

1.xi. Phone (with STD Code) __________________________
1.xii. Mobile No. ______________________________________
1.xiii. E-mail __________________________________
2 . Educational Qualifications:

Name of the Year of Name of Major Certificate/ Overall

Course Passing School/College/ Subject Degree %age and
University and Obtained Division
Place
X Std

XII Std

Graduation*

Post
Graduation
Others (IF
Any)

*In case of GPA/CGPA score, please also give conversion formula.

3. Work Experience:

(Begin with the most recent, including any short-term assignment)

Period Organisation Job Title Key Responsibilities

From- To (Dates) Name & Address
4. Particulars of Draft:

Draft. No. _________________ Date: ___________ Amount: ` 1000/-

for “ PNBIIT A/C ADBT ”.
Issuing Bank: __________________________
Payable at: LUCKNOW

I have read the complete details of the programme alongwith terms and
conditions and disclaimer statement as given in the information booklet and
have fully understood them. I also declare that the information given by me in
the application form is true and correct and understand that any falsification
and/or suppression of material information will render my candidature invalid
and I may be denied admission / expelled from the programme.

Date: Signature:____________________
Place:

Please enclose self attested photo copies of following documents along with
the application:
1. Degree Certificate(s) and certificates of std. X, XII and each year/semester
of college, alongwith supporting mark sheets.
2. Required certificate of category, if applicable.
Note:
1) Incomplete applications without supporting documents will not be
considered
2) Application Fee: ` 1000/- payable by Demand Draft favouring “Punjab
National Bank Institute of Information Technology A/C-ADBT”, payable at
Lucknow.

3) Completed application forms along with the DD should be sent to

The Programme Coordinator,

ADBT-IV (2010)
Punjab National Bank Institute of Information Technology,
Vibhuti Khand, Gomti Nagar,
Lucknow-226010.
 ADMIT CARD

(Complete Self- Correspondence address with Pin Code)

TO
Mr / Ms _____________________ Affix Photo
(In capital letters) Sign across the
Address ____________________ photo in a way that
part Signature
come on photo and
___________________ part on the paper
______________________________

(FOR OFFICE USE ONLY)

REGISTRATION NUMBER: ________________ADBT-IV (2010)

PLACE OF ONLINE ENTRANCE TEST: PNBIIT

Vibhuti Khand, Gomti Nagar,
Opp. Lohia Hospital
Lucknow.

DATE & TIME OF ONLINE ENTRANCE TEST: ________

REPORTING TIME : _________

NOTE :

1. No expenses will be reimbursed for the journey undertaken for attending

the Online Entrance Test/ Interview.
2. The candidate should bring this ADMIT CARD with him/her at the
Examination Hall.

Programme Coordinator