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2) eesielee / HeceeCeHe$eesW kee meleeHeve kejves Jeeues DeefOekeejer kee veece eer./eerceleer/ keg.
Eligibility/ Certificates verified by : Shri/Smt/ Kum. : ________________________________
______________________________________________________________________________
______________________________________________________________________________
HeceeCeHe$eesW kee meleeHeve kejves Jeeues DeefOekeejer kee Heoveece SJeb nmlee#ej
Signature & Designation of Documents Verifying Official
Heoveece
nmlee#ej
Designation ______________
Signature ____________
Yeejleere ms yeQke
STATE BANK OF INDIA
kesvere Yeleea SJeb HeoesVeefle efJeYeeie
CENTRAL RECRUITMENT & PROMOTION DEPARTMENT
(ke=Heee meeJeOeeveerHetJe&ke He{ves kes HeMeele Heece& DeHeveer nmleefueefHe ceW Yejs)
(Please fill in the form in your own handwriting after reading carefully)
(ke) ef[eer eceeCeHe$e kes Devegmeej megmHe De#ejeW ceW Hetje veece
(a)
Date of Birth
efoveebke /Date
cenervee / Month
Je<e& / Year
omleeJespe GoenjCeeLe& neF&mketue HeceeCeHe$e, HeemeHees& Fleeoer kes Devegmeej (ke=Heee meueive kejW)
As per High School Certificate, Passport, Others (please enclose) :
efpeuee :
jepe :
(b)
District :
State :
Place of Birth :
(ke) je^erelee :
(a)
Nationality : ___________________________
(ke) Oece& :
(b)
4.
Religion : _____________________________
(ke) je<^erelee
(a)
efHelee
ceelee
efpeuee
jepe
(ke) esCeer Jeie& (eLeesefele Deeele ceW mener kee efevn ueieeSW)
(a)
Heleer/Helveer
De.pee.
De.pe.pee.
meeceeve
SC
ST
GEN
(Ke) Devegmetefele peeefle / Devegmetefele pevepeeefle / Deve efHe[s Jeie& kes GcceeroJeej
peeefle/pevepeeefle /mecegoee kee veece oW
(b)
(ie) eefo DeeHe efJekeueebie nQ lees ke=Heee eLeesefele Deeele ces mener kee efevn ueieeSB
pewmes DeeefmLe efJekeueebie ee ef efJekeueebie
(c)
DeeefmLe efJeke.
ef efJeke.
OH
VH
(Ie) eefo DeeHe Meejerefjke He mes efJekeueebie nQ lees ke=Heee DeHeves efJekeueebielee kee efJeJejCe oW.
(d)
If you are a Physically Challanged person, please give details of your handicap.
(1)
7.
8.
(ke)
eefo DeeHe eleeJeefle&le /eJeemeer /efJemLeeefHele Jeeqkele neW lees Gmekee efJeJejCe oW.
(a)
(Ke)
eefo DeeHe YetleHetJe& mewefveke nQ lees ke=Heee keee&cegeqkele /mesJeeefveJe=efe keer efleefLe kee GuuesKe kejW.
(b)
(ke)
ceele= Yee<ee
(a)
Mother Tongue :
(Ke)
(b)
Yee<ee
yeesue mekeles nQ
He{ mekeles nQ
Language
Speak
Read
efueKe mekeles nQ
Write
1.
2.
3.
9.
Mew#eefCeke eesieleeDeeW kee yeesje Details of Educational Qualifications : kegue Debke SJeb eeHleebke keeuece ceW meYeer efJe<eeeW pewmes Sseqke, Heeme keesme&
ee Deeveme& keesme& kes Debke pees[kej oMee&es) (The agreegate Marks of all subject whether optional, pass course or honours
course will be shown in total marks & marks obtained coloum)
(mebye HeceeCeHe$eeW leLee Debke He$eeW keer HeefleefueefHeeeb mebueive keerefpeS) (Please enclose copies of relevant certificates & Mark-Sheets).
efJeMJeefJeeeuee/
Heeme nesves kee
He{s ieS efJe<ee
HeeHleebke
kegue Debke
Mew#eefCeke eesielee
mebmLeeve /yees[&
ceefnvee SJeb Je<e&
Educational Qualifications
University/
Institute / Board
Total Marks
Marks
Obtained
Subject
Studied
Henuee me$e
First Semester
leermeje me$e
Third Semester
HeeBeJee me$e
Fifth Semester
meeleJee me$e
Seventh Semester
mekeue Debke
Aggregate Marks
11.
(ke) Kesue leLee Heeeeceslej efeeekeueeHeeW kee efJeJejCe, efpemeceW DeeHeves Yeeie efueee nes, eeHle ieewjJe leLee efJeefMe eesielee
(a)
Particulars of sports and other extra-curricular activities in which you have participated, Credits & Distinctions obtained :
(2)
12.
13.
DeJeefOe/ Period
mes
leke
From
To
efveegefkele kee
mLeeve
Place of
Posting
kegue Jesleve
Total Emoluments
es[ves kee
keejCe
Meg cesb/
Starting
Last Drawn
leaving
(Ke) Jele&ceeve efveeeskelee keer efmLeefle (mejkeejer)/De& mejkeejer/meeJe&peefveke #es$e /efvepeer #es$e)
(b)
14.
Yeejleere ms yeQke leLee Gmekes meneesieer yeQkees ceW Yeleea kes efueS
efkeS ieS HetJe& kes meYeer HeeemeeW kee efJeJejCe
Particulars of all your previous attempts
for recruitment in State Bank of India
16.
efHeues leerve Je<eex ceW (eeuet Je<e& meefnle) efveegefkele kes efueS Deve mLeeveeW
Hej efkees ieS DeeJesoveeW kee efJeJejCe
Particulars of your application for employment
elsewhere during the last 3 years
(including current year)
DeeJesefole Heo
Hejer#ee kesv
Hejer#ee efleefLe
HeefjCeece
Post
applied for
Centre of
exam
Date of
exam
Results
Name of the
organisation
DeeJesefole Heo
HeefjCeece
Post
applied for
Resuls
eefo DeeJeMekelee nes lees Deefleefjkele Hevves kee GHeeesie kejW. ke=Heee meYeer efJeJejCe yeleeeW. Use extra sheet if required. Please disclose all details.
Yeejleere ms yeQke kes ceb[ueeW ceW Deeyebve kes efueS
eLece Jejerelee
DeHeveer Jejerelee kee efJeJejCe oW
First preference :__________________________
efleere Jejerelee
Particulars of your preference for allotment in
Circles of State Bank of India
le=leere Jejerelee
Third preference :__________________________
vees meYeer ceb[uees keer meteer SJeb Gvekes #es$e Devle ceW ueieer nw.
Note : List of all circle enclosed
17
18.
___________________________________
________________________________________
___________________________________
________________________________________
___________________________________
________________________________________
efHeve kees[
19.
efHeve kees[
Pin Code
Pin Code
Mobile No :
Mobile No :
E-mail address :
E-mail address :
Gve mLeeveeW kee efJeJejCe peneB DeeHe efHeues Heebe Je<eex kes oewjeve Ske Je<e& mes DeefOeke mecee leke jns nes
Particulars of places where you have resided for more than 1 year during the last 5 years:
mes
leke
3 vecyej kes keeuece ceW efoS ieS mLeeve kee efpeuee cegKeeuee
From
To
(1)
(2)
(3)
(3)
20.
eefo efkemeer veeeeuee ves DeeHekes efJe efkemeer DeHejeOe kes efueS DeefYeeespeve/efnjemele/oC[/oes<eefmeef kee efveCe&e efoee nes lees Gmekee efJeJejCe.
Particulars of any prosecution/detention/fine/conviction/sentence against you awarded by any court of law for any
offence.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
21.
eefo efkemeer veeeeuee ves DeeHekes efJe keesF& ceeceuee (yeQke/Deve efJeeerre mebmLeeDeeW keer $eCe Deoeeieer vener kejves mes mebyebefOele ceeceues meefnle)
efJeeejeOeerve nes lees Gmekee efJeJejCe.
Particulars of cases pending against you in any court of law including case (s) for non-payment of any loan from
Banks/ Financial Institutions.
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
22.
eefo efkemeer mesJee Deeeesie, Hejer#eCe mebmLee ves DeHeveer egveeJe Hejer#ee ceW Deeesie Ieesef<ele efkeee nes/jeske ueiee oer nes, lees Gmekee efJeJejCe.
Particulars of disqualification/ debarment by any Service Commission, examining body at their selection/examination:
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
23.
DeeHekes Jele&ceeve DeLeJee Henues efveeespeke (keeW) eje DeeHekes efJe eejbYe efkeS ieS / efJeeejeOeerve DevegMeemeveelceke keee&Jeener kee efJeJejCe, eefo
DeeHekees efkemeer HeoesVeefle Hejer#ee ceW yewves Hej jeske ueieeF& ieeer nes lees Gmekee Yeer efJeJejCe oW.
Particulars of any case (s) of disciplinary action instituted/ pending against you by your present or previous employer
(s). Please also state whether you were debarred from appearing in any promotional examination.
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
24.
25.
kece mebKee
Sr. No.
veece
Helee
Name
Address
Tel. No.
1.
2.
26.
Deve efJeJejCe pees yeQke kes efueS GHeeesieer nes mekeles neW.
Additional particulars, if any, which may be of use to the Bank : ___________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
cewQ HeceeefCele kejlee / kejleer nt@B efke GHeeg&kele efJeJejCe cesjer Hetjer peevekeejer leLee efJeMJeeme kes Devegmeej mele, mener Je HetCe& nw. cewQ Ssmeer efkemeer Yeer yeele mes
DeJeiele venerR nt@b pees cegPes yewQke keer veewkejer kes efueS Gheegkele nesves cesW yeeOeke efme nes mekeleer nw. cewQ Yeejle cesW efkemeer Yeer mLeeve Hej DeLeJee efJeosMe cesW mesJee kes efueS
DeHeveer menceefle oslee/osleer nt@B, cewQ en Yeer Iees<eCee kejlee /kejleer nt@B efke cegPes onspe Heefle<es<e DeefOeefveece 1961 kes Debleie&le DeLeJee efJeefOe kes Devegmeej oC[veere
efkemeer DeHejeOe kes ceeceues cesW keYeer Yeer oefC[le venerR efkeee ieee nw.
eefo cesjs eje Hemlegle efkeee ieee efJeJejCe ieuele ee Demele Heeee peelee nw Deewj / ee Heece& Hemlegle kejles mecee JeemleefJeke leLeesW kee efHeeee peevee yeeo keer
efleefLe ceW Helee euelee nw lees yeQke kees cesjer efveegefkele, efveegefkele kes HemleeJe meefnle, pewmee Yeer ceeceuee nes, j kejves kee DeefOekeej nesiee. GHejeskele efJeJejCe Yeejleere
ms yeQke kes efJe%eeHeve keceebke meerDeejHeer[er /HeerDees/2012-13/04 efoveebke 23.01.2013 kes Helegej ceW cesjs DeeveueeFve DeeJesove kes mebyebOe ceW Hemlegle efkees
iees nw.
I certify that the particulars furnished above are true, correct and complete to the best of my knowledge and belief. I am not
aware of any circumstance which might impair my fitness for employment in the Bank. I am willing to serve anywhere in
India and in any other country. Further, I declare that I have never been convicted for any dowry offence under the Dowry
Prohibition Act, 1961, or any criminal offence under any other law.
In case the particulars submitted by me are found to be false or not true and / or suppression of material facts by me while
submitting the form is revealed at a latter date, the Bank shall have the right to cancel the appointment including the offer for
appointment, as the case may be. The above details are submitted in reference to State Bank of India advertisement No. CRPD
/ PO/2012 - 13/04 Dated 23.01.2013 & my online application thereto.
mLeeve Place :
efoveebke Date :
mebueive efkeee
Enclosed
Not enclosed
1) Deeeg kee mee#e HeceeCeHe$e kee veece (neF&mketue HeceeCeHe$e, HeemeHees& Fleeefo)
1)
2)
3) mveeleke Debke-leeefuekee (ke=Heee mHe< He mes GuuesKe kejs pewmes yeer.S./yeer.Smemeer Fleeefo)
3)
Henuee me$e
First Semester
leermeje me$e
Third Semester
HeeBeJee me$e
Fifth Semester
meeleJee me$e
Seventh Semester
mekeue Debke
Aggregate Marks
(5)
6)
(if any)
Employer
9) DevegYeJe HeceeCeHe$e
9) Experience Certificate
10) efJecegefkele HeceeCeHe$e
10) Discharge Certificate
11) yeej keeGbefmeue / cesef[keue keeGbefmeue cesW HebpeerkejCe
11) Registration with Bar Council / Medical
12) ces[erkeue esCeer mes mebyebefOele HeceeCeHe$e
12) Certificate regarding Medical
Council
Category
efoveebke
Date :
Signature of candidate
(6)
efkemeer Yeer HeosMe/kesv mejkeej kes jepeHeef$ele DeefOekeejer, meebmeo, SceSueS, Sce.Sue.meer ee Yeejleere ms yeQke ee efkemeer je<^ere ke=le yeQke kes MeeKee
cegKe eje peejer efkeee peevee eeefneW.
To be issued by a Gazetted officer of state/ Central Govt. MLA, MLC, MP Branch Head of State Bank of India or a
Nationalised Bank
eer ______________________ kees efHeues _________ Je<eesx ________cenerveesW mes peevelee/ peeveleer nt@b leLee cesjer peevekeejer leLee
efJeMJeeme kes Devegmeej Gvekes eje efoee ieee GHeeg&kele efJeJejCe mener nw.
Shri____________________________________for the past ________ years ________ month/s and that to the best of my
knowledge and belief the particulars furnished above by him/her are correct.
mLeeve Place :
nmlee#ej Signature
efoveebke Date :
Heoveece Designation
Helee
ceesnj
SEAL
(7)
Address
I______________ _____________________________________________________
Son/daughter of Shri ____________________________________________________
Resident of village/ town/city ___________________ District ______________________
State _____________________________________________ . Hereby declare that I
belong to the ____________________________________________ Community which
is recognised as a backward class by the Government of India for the purpose of reservation
in services as per orders contained in Department of Personnel and Training Office
Memorandum No. 36012/22/93-Estt.(SCT) dated 08.09.1993. It is also declared that I do
not belong to persons / sections (Creamy Layer) mentioned in column 3 of the Schedule
to the above referred Office Memorandum dated 08.09.1993.
Place :
Dated
Deve efHe[s Jeie& kes He ceW Deej#eCe keer ceebie kejvesJeeues Deve efHe[s JeieeX kes
GcceeroJeejeW eje emlegle keer peevesJeeueer Iees<eCee
ceQ ______________ ___________________________________________________
mLeeve
efoveebke
1)
Ahmedabad
2)
Bangalore
Karnataka
3)
Bhopal
4)
Bhubaneswar
Orissa
5)
Chandigarh
6)
Chennai
7)
Guwahati
8)
Hyderabad
Andhara Pradesh
9)
Kolkata
10)
Lucknow
11)
Mumbai
12)
Delhi
13)
Patna
14)
Kerala