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ONLINE APPLICATION FORM FOR THE POST OF PROBATIONARY OFFICERS

29035
Please paste your recent
passport size photograph
and sign across it. Please
retain atleast 5 copies of
same photograph with you
for subsequent use.

Registration # : 134498
Full Name : KULKARNI AMOL SHAMRAO
Category : GENERAL
If person with disability : NO
Type of Disability : - Percentage of Disability : --
Do you intend to use the services
of a scribe (only for VI and OC those candidates whose --
writing speed has been affected by cerebral palsy):
Whether you belong to Religious Minority Community? NO
Religion to which you belong :

Are you an Ex-Serviceman ? NO

Nationality : INDIAN
Region Preference : Western
Centre for Examination : : Pune
Centre code : 58

Application Fee / Postal Charges Details :

Transaction ID : AA186818
Branch Name : KURDUWADI
Branch SOL ID : 47020

Deposit Date : 12-11-2010 Amount : 300

Personal Details :
Age completed as on
Date of Birth : June 1984,16 26
31.10.2010 :

Gender : MALE
Marital Status : Married

Father's Name/ Husband's Name : SHAMRAO KULKARNI

Mother's Name : REKHA KULKARNI

Address for Correspondence : A/P-BITALE

TQ -MOHOL
District DIST SOLAPUR

State : MAHARASHTRA Pin : 413214

Permanent Address : A/P-BITALE

TQ -MOHOL
District DIST SOLAPUR

State : MAHARASHTRA Pin : 413214

Contact Details:
Phone No : 02189-287305 Mobile No : 9850309099
Email ID : kulkarniask@rediffmail.com
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Qualification Details (as on 31.10.2010):

Exams Passed Subject/Stream Year Of Passing % of Marks

Graduation : B.Sc 2005 63.00

Post Graduation : MSW 2007 67.00

Diploma in Banking & Finance (DBF)

NO
from the Indian Institute of Banking & Finance (IIBF) :

Knowledge of Computer : YES

Details of Computer Knowledge Qualification : Passed certificate course in computer application

Post Qualification work experience details as on 31.10.2010. (Start from present Employer):

Name of the Designation and rank, if From(mm/yyyy) To(mm/yyyy) Nature of Duties Reason of Years of Service
Employer any Performed leaving (YY-MM)
BASIX Branch Head 02/2008 11/2010 Heading entire branch NA 02/09
operation

Other Details :
Whether undergone Pre-Exam Training for Officers before : NO

Would You like to undergo Pre-Exam

Training (SC/ST/Ex-Servicemen/Religious NO
Minority Community) :

If Yes Centre for Training :

Languages Known Read Write Speak

English YES YES YES

Marathi YES YES YES

Hindi 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 criteria according to the advertisement, then my candidature will be rejected/services 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 the advised criteria in respect of age, educational
qualification and experience etc.

I am also willing to serve anywhere in India. I agree that the Bank has the right to transfer me to any part of the country and/or to any
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 or claims or disputes arising out of application or out of said advertisement can be
instituted by me only at NCT, Delhi only, shall have sole and exclusive jurisdiction to try any cause/dispute. I undertake to abide by all the terms and conditions in
the advertisement given by the Bank.

Place:
Date: 12-11-2010 Signature of Applicant

KULKARNI AMOL SHAMRAO

Please retain your Registration No. and Password emailed to you carefully for further reference
Note : Please do not send the application print out to the Bank.