PRESCRIBED PROFORMA
APPLICATION FOR THE POST OF _______________________
Male Candidate _________ Female Candidate ________________
1. Full Name of applicant (in Block Letters): __________________
2. Father’s Name : ______________________________________
3. a) Amount of fee __________________________________
b) Demand Draft No. & date _________________________
c) Name of Branch of State Bank of India payable at New Delhi _________________
4. Date of Birth Day __________ Month _____________ Year _________
(in words) ____________________________________________________________
a) Age as on 30.11.2010 Year _________ Month _______ Day __________
5. Are you a citizen of India __________________________________________________
by birth or by domicile?
6. Permanent Address:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
7. Postal Address:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
8. Category SC/ST/OBC/Genl: _______________________________________
Category code (Genl. – 01, Sc – 02, ST
9. Whether PH/Ex. Service man, if any: _________________________________
Code – (PH – 05) (Ex./SM – 06)
10. Educational & Technical Qualification (From Matriculation onwards for Gr.’C’ & Middle
onwards for Gr. ‘D’ posts):-
11. Experience / particulars of previous and present employment:-
S.No. Examination Passed University / Subjects %age of Year of
Board Marks Passing
12. Details of other academic and professional achievements and extra curricular activities:-
S.No. Name and full Designation/ Scale of Pay Period of employment
Address of Duties From To
Employer
13. List of Enclosures: 1. …………………………. 2. ……………………………….. 3. ………………………………
4. …………………………. 5. ……………………………….. 6. ………………………………
DECLARATION
I do hereby declare that all the statements made in the application are true. Complete and
correct to the best of my knowledge and belief. I also declare that I have submitted one
application only. I am fully aware that in the event of any particulars or information furnished by
me being found to be false/incorrect/incomplete or for indulging in some unlawful act, my
candidature for the post is liable to be summarily rejected/ cancelled and in the event of any
statement/information submitted found false/incorrect even after my appointment, my services
are liable to be terminated without any notice.
Left Thumb Impression of Candidate
Signature of Candidate
(Space for Left Thumb impression) (Space for Signature)
Date : __________________ Name of Candidate : ___________
Place : __________________
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE
(IN ADDITION TO THE COMMUNITY CERTIFICATE (OBC)
I ………………………………………. son/daughter of Shri ……………………………………………….
resident of Village / town / city ………………………………… district state ………………………………
hereby declare that I belong to the …………………………………………………. community which is
recognized 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. 36102 / 22 / 93 – Esstt. (SCT) dated 8-9-93. It is also declared that I do
not belong to persons / sections (Creamy Layer) mentioned in column 3 on the Schedule
to the above referred Office Memorandum dated 8-9-1993.
(SIGNATURE OF THE CANDIDATE)
Full Name : ………………………………..
Address :
