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ON-LINE APPLICATION FOR MGB GRAMIN BANK

24035
Please paste your recent
Post Box No. 7479 passport size photograph
and sign across it. Please
Jogeshwari (East)
retain atleast 5 copies of
Mumbai 400 060 same photograph with you
for subsequent use.

Registration # : 12993
Full Name : Ankur Mahawar
Post : Office Assistant
Post Code : 01
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 & OC candidates whose writing speed is NA
affected by cerebral palsy)? :
Whether you belong to Religious Minority Community? : NO
Minority Religion : -
Are you an Ex-Serviceman? NO
Are you a Disabled Ex-Serviceman (DISXS)? NO
Are you a Dependent of an Ex-Serviceman (DXS)? NO
Are you seeking relaxation under widow / divorced women /
NO
women judicially Separated from their husbands and who are not re-married?
Are you candidate who had ordinarily been domiciled in
NO
Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989?:
Nationality : Indian

Centre of Examination : Bikaner

Centre code : 12

Application Fee / Postal Charges Details :

Name of Issuing bank : Union bank of India

Place of Issue : Ajmer

Demand Draft No. : 911128

MICR No : 305026002
Date of Deposit : 26-04-2011

Amount : 400

Personal Details :
Date of Birth : 11-07-1988 Age as on 01.04.2011. : 22
Gender : MALE

Marital Status : UnMarried

Husband's Name / Father's Name : Mr. Suresh mahawar

Mother's Name : Mrs. Manju mahawar

Address for Correspondence : Ghar-sansar New Keseri Colony
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Adarsh Nagar Ajmer
District Ajmer

State : RAJASTHAN

Pin : 305001
Permanent Address : Ghar-sansar New Keseri Colony

Adarsh Nagar Ajmer

District Ajmer

State : RAJASTHAN
Pin : 305001

Contact Details:
Phone No : 0145-2682038

Mobile No: 9460570651

Email ID : ankur_boss1@yahoo.com

Qualification Details (as on 01.04.2011):

Exams Passed Name of the Year of Passing % of Marks Class / Grade

Subject/Stream
Graduation/Equivalent : Others 2008 52.25 Second Class

Working Knowledge of Computers : YES

Details of Computer Knowledge : Computer Basic and Tally

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

Name of the Employer & Designation and Rank From(mm/yyyy) To(mm/yyyy) Nature of Reason for Leaving Years of
Nature of Employment Duties Performed Service
(YY/MM)

Total Relevent Experience ( in months) : -

Other Details :
Would You like to undergo Pre-Exam Training (SC/ST/Minority Community) : -

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 criteria 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 Pali - Marwar and courts/ Tribunal/ forums at Pali - Marwar 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: 26-04-2011 Signature of Applicant

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Ankur Mahawar
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