ON-LINE APPLICATION FOR BANK OF BARODA CLERKS RECRUITMENT PROJECY

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passport size photograp`
and sign across it. PleasR
retain atleast 5 copies oe

Please paste your recenW

same photograph with yoZ

for subsequent usec

Registration # m
336057q
Full Name m
Mr BANSAL JATINU

Category k
GENERAq
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If Person with Disability k
Nt
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Type of Disability k
-v
Percentage of Disability k
-v
Do you intend to use the services of a scribe( only for VH anb

-v

OH candidates whose writing speed is affected by cerebral palsy) k

Are you candidate who had ordinarily been domiciled in KashmirU

Nt

Division of the State of J&K during the period 1-1-1980 to 31-12-1989Y

Are you Children/family members of those who died in 1984 riotT
Nt
Whether you belong to Religious Minority CommunitX
Nt
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Minority Religion k
-v
Are you an Ex-Serviceman (Including ECO/SSCO)Y
Nt
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Are you a disabled Ex-Serviceman (DISXSV
Nt
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Are you a dependent of an Ex-Serviceman (DXSV
Nt
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Have you passed in Service (Departmental) Examination which is equivalenW

Nt
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to Civil Examination not below the rank of HSCY

Are you seeking relaxation under widow/divorced women/women judiciallyZ

Nt
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Separated from their husbands and who are not re-marriedY

District Preference for Posting m

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District Preference 1 k
GHAZIABAs
District Preference 2 k
DELHr
District Preference 3 k
SAHIBABAs
Are you an employee of Bank of Baroda k
Nt
If yes,E. C. No k
Nationality k
INDIAn
State / Union Territory for which you are applying k
Delh^
State / UT code k
1[
Centre of Examination k
DELHr
Centre code k
3_
Application Fee / Postal Charges Details m
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Transaction ID k
M36482\
Branch Name k
RAJENDRA NAGAR GZ2
Branch Code No k
RAJIND304\
Deposit Date k
02-02-201Y
Amount k
20\

Personal Details m
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Date of Birth k
July 10,199\
Age as on on 01.01.2011. k
2\
Gender k
MALm
Father's Name/ Husband's Name k
RAJESH BANSAq
Mother's Name k
SWATI BANSAq
Email ID k
jbansal7@gmail.cof
Address for Correspondence k
C-2/119 AMBICA-2 RADHY SHYAM PARW
SAHIBABAs
DistricW
GHAZIABAs
State k
UTTAR PRADESU
Pin k
20100d
Permanent Address k
C-2/119 AMBICA-2 RADHY SHYAM PARW
SAHIBABAs
DistricW
GHAZIABAs
State k
UTTAR PRADESU
Pin k
20100d
Contact Detailsm
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Phone No k
0120-263844[
Mobile Nok
9013260255
Qualification Details (as on 01.01.2011)k

Exams PassedSubject/StreamUniversity / BoardYear Of Passing% of MarksHSC / Equiv

alent :COMMERCECBSE23-05-200868.00
Diploma in Banking k
Nt
Possess certificate in computer literacy k
YEX

Post qualification work experience details as on 01.01.2011 (Start from Present

Employer) m

No Experience
Other Details m
Whether desirous of taking Pre-Exam Trainina
(SC/ST/PWD/Minority Community) k
-v
If Yes Centre for Training k
-v
Languages KnownReadWriteSpeakEnglishYESYESYESHINDIYESYESYES
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DECLARATIONm

I hereby certify that the information furnished above is correct to the best of
my knowledge and belief. I have not suppressed any material fact o[
factual information in the above statement. I am aware, that, in case, I have gi
ven wrong information or suppressed any material fact or factual information or,
I dY
not satisfy the eligibility criteria according to the advertisement, then my can
didature will be rejected/services terminated even after permanent employmenW
without giving any notice or reasons thereofc

I hereby certify that I am satisfying the eligibility criteria for the post app
lied for in terms of the advised criteria in respect of age, educationaQ
qualification and experience, etcc

I am also willing to serve anywhere in India. I agree that the Bank has the rig
ht to transfer me to any part of the country and/or to an.

job position at its sole discretion in terms of applicable staff rules from time
to time}
I hereby agree that any legal proceeding in respect of any matter(s) or claims o
r disputes arising out of this application or out of said advertisemenW
can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai onl
y, shall have sole and exclusive jurisdiction to try any cause/dispute. r
undertake to abide by all the terms and conditions mentioned in the advertisemen
t given by the Bankc
Placem
Date: 02-02-201|
Signature of Applicang
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Please retain your Registration No. and Password emailed to you carefully for fu
rther referencc
NOTE: Please DO NOT SEND application print-out to the Ban.
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BANSAL JATINU
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