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Recruitment of Officer MMG Scale III, Officer MMG Scale II, Officer JMG Scale -I and Office Assistant (Multipurpose)

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Please paste your recentpassport size photograph

and sign across it. Please

retain atleast 5 copies of

same photograph with you

for subsequent use.

Registration #: 1038721

Full Name : PUJA SINGH

Post : Office Assistant (Multipurpose)

Post Code : 04

Category : GENERAL

If physically challenged : NO

Type of Disability : -

Percentage of Disability : -

Do you intend to use the services of a scribe (only for VI & OC candidates

whose writing speed is affected by cerebral palsy) :NA

Whether you belong to Religious Minority Community? : NO

Religion to which you belong : --

Whether domiciled in Kashmir Division of the

State of J&K during the period 1-1-1980 to 31-12-1989 ? :NO

Are you an Ex-Serviceman? : NO

Date of Discharge : -

Are you a disabled Ex-Serviceman (DISXS)? : NO

Period of service rendered in defence services as an Ex Serviceman (in months) : --

Are you Dependent Ex-Serviceman (DXS)? : NO

Are you seeking relaxation under widow / divorced women / women judicially Separated

from their husbands and who are not re-married? :

NO

Nationality : INDIAN

Centre of Examination : Patna

Centre code : 11

Application Fee / Postal Charges Details :

Payment In : Punjab National Bank

Transaction ID : M121252

Branch Name : PNB ANISHABAD PATNA

Branch Code No : 6059

Deposit Date : 10-03-2012

Amount : 450

Personal Details :

Date of Birth : 04-09-1991

Age completed as on 01.04.2011: 19

Gender : FEMALE

Marital Status : Unmarried

Father's Name / Husband's Name : TARA PRASAD SINGH

Mother's name : LILA DEVI

Contact Details:

Address for Correspondence : SINGH MORE VIKASH NAGAR

LATMA ROAD NO 8/B NEAR MISSION

HOSPITAL HATIA

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District : RANCHI

State : JHARKHAND

Pin code : 834003

Permanent Address : SINGH MORE VIKASH NAGAR

LATMA ROAD NO 8/B NEAR MISSION

HOSPITAL HATIA

District : RANCHI

State : JHARKHAND

Pin code : 834003

Contact Details :

Phone Number : -

Mobile Number : 9835130131

Email ID : sanjeevsingh.ece@gmail.com

Qualification Details (as on 01.04.2011):

Exam Passed Name of the Subject/Stream Year of Passing % of Marks Class/Grade

Graduation /

Equivalent :

Science2011 65.00 First Class

Working Knowledge of Computers : YES

Details of Computer Knowledge : MS WORD

Post Qualification work experience details (Start from present Employer):

Name of the Employer &

Nature of Employment

Designation and Rank From(mm/yyyy) To(mm/yyyy) Nature of duties performed Reason for Leaving Year of Service

(YY/MM)

Total Experience (in months) : -

Other Details :

Whether desirous of taking Pre-Exam Training (Only for

SC/ST/Minority/EXS ) :--

If Yes Centre for Training : --

Languages Known Read Write Speak

Hindi YES YES YES

ENGLISH YES YES YES

DECLARATION:

I hereby certify that the above information furnished is correct to the best of my knowledge and belief. I have not suppressed any material fact or factual information in the above statement. I am

aware that in case I have given wrong information or suppressed any material fact or factual information or I do not satisfy the eligibility cr iteria according to the advertisement, then my candidature will be

rejected/ service terminated even after permanent employment without giving any notice or reasons thereof.

I hereby certify that I am satisfying the eligibility criteria for the post applied for in terms of advised criteria in respect of age, caste, educational qualification etc.

I hereby agree that any legal proceeding in respect of any matter or claims or disputes arising out of application or out of said advertisement can be instituted by me only at Muzaffarpur and

courts/ Tr ibunal/ forums at Muzaffarpur only, shall have sole and exclusive jurisdiction to any cause/ dispute. I undertake to abide by all the terms and conditions in the advertisement given by the Bank.

Place:

Date: 13-03-2012 Signature of Applica

PUJA SING

Please retain your Registration No. and Password emailed to you carefully for further reference

NOTE: Please DO NOT SEND application print-out to the Bank

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