UNITED BANK OF INDIA

APPLICATION FORM
Paste here
UBI Probationary/IT Officers’ Recruitment Project-2005 your recent
Post Box No. passport size
photograph &
Mumbai- sign it across
(Write the relevant Post Box No., Area & Pin code for your
post as given in the advertisement in clause no. 11)

With reference to your advertisement in the Employment News dated , I submit my

application in the prescribed format.

1. FULL NAME IN BLOCK LETTERS : (leave one space blank between two parts of your name)
Mr./Ms.

(As it appears on your educational certificates)

2(a) CANDIDATE’S ADDRESS FOR CORRESPONDENCE

Pin-
Tel. No.(with STD Code) _________________________
E-Mail _________________________

3 CENTRE OF WRITTEN ____________________ CENTRE CODE NO.

EXAMINATION (IF APPLICABLE)

4 POST APPLIED FOR ____________________ POST CODE NO.

5 (a) INDICATE CATEGORY TO WHICH YOU BELONG BY MARKING ““ IN THE

APPROPRIATE BOX

SC ST OBC GEN

In case of SC/ST/OBC candidate (Please enclose attested photocopy of certificates):

i) Name of the ________________ ii) Name of the state to which you belong
___________
caste/tribe/class
(b) In case of PH candidate, indicate by marking ““ in the OH VH HI
appropriate box
Please mention percentage of disability
__________________________________
(Please enclose attested photocopy of certificates)
(c) Do you intend to use the services of a scribe Yes No
6 PARTICULARS OF APPLICATION FEE (DEMAND DRAFT/PAY ORDER):

Name & address of the Drawn in favour of Date of Issue DD/Pay Order Amount
issuing bank/branch Number
United Bank of India
Recruitment Project-2005
(Payable at Mumbai)
{Fee for each post is Rs.200/- for General category candidates including OBC and Rs.50/- for
SC/ST/PH category candidates} (The candidates belonging to SC/ST/PH category must enclose
an attested copy of caste/PH certificate) Cash, cheque, money order, postal orders, postal stamps
will not be accepted.

7 I AM APPLYING FOR BOTH THE POSTS AND SENDING Yes No

SEPARATE APPLICATION FOR BOTH THE POSTS (mark
“” in appropriate box)

8 TO BE FILLED IN ONLY BY THOSE SC/ST/MINORITY COMMUNITY CANDIDATES,

WHO ARE DESIROUS OF TAKING PRE-EXAM TRAINING. (ONLY FOR THE POST OF
PROBATIONARY OFFICER – POST CODE NO.1)
(i) Do you belong to any of the following categories
(Please tick Box)
SC ST Minority Community

(ii) Would you like to undergo pre-exam training Yes No

(iii) If yes, choice of centre for pre-exam training Bhubaneswar Guwahati Kolkata Patna
(mark “” in the appropriate box)

9 (a) DATE OF BIRTH

(as per SSC certificate) Date Month Year
(b) Age as on 01.10.2004 :
Years Months Days
(c) Place of Birth Town __________ Distt._____________ State _______________

10 (a) Are you an Ex-serviceman? Yes No.

In case of Ex-serviceman/Commissioned Officer/Police Officer/other equivalents, specify
1. Date of Discharge
2. Rank at present/last held A Acting _______________ w.e.f. _______________
B Substantive _______________ w.e.f. _______________
(b) Are you a candidate who had ordinarily been domiciled in Kashmir Yes No
Division of the state of J&K during the period of 01.01.1980 to 31.12.1989
(c) WHETHER YOU BELONG TO MINORITY COMMUNITY? Yes No
If yes, please state the religion :
 (d) Are you an RRB employee? Yes No

11 GENDER Male Female (mark “” in appropriate box)

12 NATIONALITY: _________________
13 a) EDUCATIONAL & PROFESSIONAL QUALIFICATION : MATRICULATION/SSLC
ONWARDS AS ON 1.10.2004
Examination Passed Name of the Subjects studied Date, Month & Percentage of
Institution/University in detail Year of Passing aggregate marks

14 PARTICULARS OF POST QUALIFICATION EXPERIENCE AS ON 01.10.2004:

Name of the employer(s) Designation Period of Length of Nature of Remarks

etc. & details of Service Service duties (reasons for
activities carried out by performed in leaving
the employers detail service)
From To Year Month

15 FATHER’S/HUSBAND’S NAME
16 PERMANENT ADDRESS

Pin-

17 LANGUAGES KNOWN : (mark “” in appropriate box)

(A) _____________(Read) (Write) (Speak) (C) _____________(Read) (Write) (Speak)

(B) _____________(Read) (Write) (Speak) (D) _____________(Read) (Write) (Speak)

I hereby declare that all statements made in this application are true, complete & correct to the best of my
knowledge and belief. I understand that in the event of any information being found false or incorrect at
any stage or not satisfying the eligibility criteria according to the requirements of the relative
advertisement, my candidature/appointment is liable to be cancelled/terminated. I am willing to serve
anywhere in India. I agree that bank has the right to transfer me to any part of the country at its discretion.
I hereby agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of
this application and/or out of the said advertisement can be instituted by me only at Kolkata and
Courts/Tribunals/Forums at Kolkata only shall have sole and exclusive jurisdiction to try any
cause/dispute. I undertake to abide by all the terms & conditions mentioned in the advertisement given by
the bank.
Place :_________________ SIGNATURE OF CANDIDATE
Date :_________________