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ON-LINE APPLICATION FOR RECRUITMENT FOR THE POST OF OFFICER MM SCALE-III,II,JM SCALE-I GROUP A & OFFICE ASSISTANT GROUP B

19025

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 # : Full Name : Post : Post Code : Category : If Physically Challenged : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe(only for VI & OC candidates whose writing speed has been affected by cerebral palsy) ? : Whether you belong to Religious Minority Community ? : Religion to which you belong : Are you an Ex-Serviceman ? : Are you a Disabled Ex-Serviceman (DISXS) ? : Actual Period of service rendered in defence services as an Exserviceman (in months) : Are you a dependent of an Ex-Serviceman (DXS) ? : Are you seeking relaxation under widow/divorced women/women judicially/ Separated from their husbands and who are not re-married ? : Are you candidate who had ordinarily been domiciled in Kashmir Division of the State of J&K during the period 1-1- 1980 to 31-12-1989 ? : Domicile of Kerala State : Nationality : Centre of Examination : Centre code : Application Fee / Postal Charges Details : Transaction ID : Branch Name : Branch Code No. : Date of Deposit : Amount :

10495 Sreelekha. S. Kumar Law Officer MM Scale - II - Group "A" 06 GENERAL NO NA NO -NO NO

NO NO NO YES Indian Thrissur 12

93 South branch Ernakulam 806 25-08-2011 450

Personal Details : Date of Birth : Age completed as on 01.07.2011 : Gender : Father's Name/Husband's Name : Mother's name : 01-06-1980 31 FEMALE T.J.Lakshmanan Ammukkutty V.K.

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Address for Correspondence : 2 B/5 Penta Queen Flats Padivattom Kochi-24 District : State : Pin : Permanent Address : Ernakulam KERALA 682024 2 B/5 Penta Queen Flats Padivattom Kochi-24 District : State : Pin : Contact Details: Phone No : Mobile No : Email ID : Qualification Details (as on 01.07.2011): Exam Passed Graduation / Equivalent : Professional Qualification : Name of the Subject / Stream Law LLB NO YES Diploma in computer Applications Year of Passing 01-11-2000 28-11-2002 % of Marks 76.00 67.00 0484-2807208 8129100416 sreelekha.laxman@gmail.com Ernakulam KERALA 682024

Diploma in Banking recognized by State/ Central Government/ Union Territory : Working Knowledge of Computers : Details of Computer Knowledge : Post Qualification work experience (Start from present Employer): Name of the Employer & Nature of Employment Lulu International Mall Pvt Ltd Horizon Ventures P vt Ltd Edappally Abdul Rahim Lawyer s firm Total Experience (in months) : Other Details : Would You like to undergo Pre-Exam Training (SC/ST/ EXS/Minority): If Yes ,Centre for Training : Languages Known Malayalam English Hindi Tamil Read YES YES YES NO --Designation and Rank From(mm/yyyy)

To(mm/yyyy)

Nature of Duties Performed Advising the Compa ny in legal Matte overall preparatio n of Agreements Practised in High court and lower

Reason for Leaving

Years of Service (YY/MM) 0/10 3/2 4/3

Legal Officer Legal Manager Practising Advocat e

09/2010 06/2007 02/2003

07/2011 08/2010 05/2007

Still Continuing For better prospec ts For better prospec ts

99

Write YES YES YES NO

Speak YES 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

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Malappuram and courts/ Tribunal/ forums at Malappuram 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: 30-08-2011 Signature of Applicant

Sreelekha. S. Kumar

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