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ON-LINE APPLICATION FOR BANK OF BARODA CLERKS RECRUITMENT PROJECT

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

Registration # : 3285610
Full Name : Mr DAS NEMAI CHANDRA

Category : SC

If Person with Disability : NO

Type of Disability : -- Percentage of Disability : --

Do you intend to use the services of a scribe( only for VH and
--
OH candidates whose writing speed is affected by cerebral palsy) :
Are you candidate who had ordinarily been domiciled in Kashmir
NO
Division of the State of J&K during the period 1-1-1980 to 31-12-1989?
Are you Children/family members of those who died in 1984 riots NO

Whether you belong to Religious Minority Community NO

Minority Religion : --

Are you an Ex-Serviceman (Including ECO/SSCO)? NO

Are you a disabled Ex-Serviceman (DISXS) NO

Are you a dependent of an Ex-Serviceman (DXS) NO

Have you passed in Service (Departmental) Examination which is equivalent to Civil Examination
NO
not below the rank of HSC?
Are you seeking relaxation under widow/divorced women/women judicially/ Separated from their
NO
husbands and who are not re-married?
District Preference for Posting :

District Preference 1 : BURDWAN

District Preference 2 : HOOGHLY

District Preference 3 : KOLKATA

Are you an employee of Bank of Baroda : NO

If yes,E. C. No :

Nationality : INDIAN

State / Union Territory for which you are applying : West Bengal

State / UT code : 38

Centre of Examination : KOLKATA

Centre code : 47

Application Fee / Postal Charges Details :

Transaction ID : M577271

Branch Name : BURDWAN

Branch Code No : 0906

Deposit Date : 31-01-2011

Amount : 50

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Personal Details :
Date of Birth : December 11,1978 Age as on on 01.01.2011. : 32

Gender : MALE

Father's Name/ Husband's Name : RABINDRA NATH DAS

Mother's Name : CHHAYA RANI DAS

Email ID : nemaidas78@rediffmail.com

Address for Correspondence : VILL- KHANDAGHOSH (LALU BATI)

POST + PS - KHANDAGHOSH

District BURDWAN

State : WEST BENGAL

Pin : 713142

Permanent Address : VILL- KHANDAGHOSH (LALU BATI)

POST + PS - KHANDAGHOSH

District BURDWAN

State : WEST BENGAL

Pin : 713142

Contact Details:
Phone No : -

Mobile No: 9062695073

Qualification Details (as on 01.01.2011):

Exams Passed Subject/Stream University / Board Year Of Passing % of Marks

HSC / Equivalent : ARTS WBCHSE 01-07-2000 39.99

Graduation : ARTS VISHVA BHARATI UNI 01-07-2003 50.13

Diploma in Banking : NO

Possess certificate in computer literacy : YES

Post qualification work experience details as on 01.01.2011 (Start from Present Employer) :

No Experience

Other Details :

Whether desirous of taking Pre-Exam Training

NO
(SC/ST/PWD/Minority Community) :
If Yes Centre for Training : --

Languages
Read Write Speak
Known

English YES YES YES

BENGALI YES YES YES

HINDI NO NO YES

ORIYA NO YES YES

DECLARATION:
I hereby certify that the information furnished above 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.

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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(s) or claims or disputes arising out of this application or out of said advertisement
can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai only, shall have sole and exclusive jurisdiction to try any cause/dispute. I
undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank.

Place:
Date: 31-01-2011 Signature of Applicant

DAS NEMAI CHANDRA

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

http://registration.sifyitest.com/bobcl/registration_print.php 1/31/2011