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ON-LINE APPLICATION FOR SINGLE WINDOW OPERATOR(SWO)

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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 #: 3236334
Full Name: VEANKTESHWAR CHATURVEDI

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 VI & OC
NO
candidates whose writing speed is affected by cerebral palsy)?:
Whether domiciled in Kashmir Division of the State
NO
of J & K during the period 1-1-1980 to 31-12-1989 ?
Whether you belong to Religious Minority Community? : NO
Religion to which you belong : --
Whether Children / Family members of those who died in 1984 riots? : NO
Are you an Ex-Serviceman? : NO
Are you a disabled Ex-Serviceman (DISXS)? : NO

Period of Service in months : --

Are you a dependent of an Ex-Serviceman (DXS)? : NO
Are you seeking relaxation under widow/divorced women/
women judicially Separated from their husbands and who are NO
not re-married :
Nationality : INDIAN
State / Union Territory for which you are applying : Chattisgarh
State code : 19

Centre of Examination : Bhopal

Centre code : 30

Application Fee / Postal Charges Details :

Transaction ID : M4403902

Branch Name : PNB SADAR BAZAR BILASPUR

Branch Code : 005800

Date of Deposit : 30-04-2011

Amount : 50

Personal Details :
Date of Birth : 04-01-1987

Age as on 01.01.2011: 23
Gender : MALE

Father's Name / Husband's Name : BHAGWAT PRASD CHATURVEDI

Mother's Name : MEENA BAI CHATURVEDI

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Address for Correspondence : GURU GHASI DAS NAGAR TIRANGA

CHOWK KUSHALPUR RAIPUR (C.G)

District RAIPUR

State : CHHATTISGARH
Pin : 492001

Permanent Address : GURU GHASI DAS NAGAR TIRANGA

CHOWK KUSHALPUR RAIPUR (C.G)

District RAIPUR

State : CHHATTISGARH
Pin : 492001

Contact Details:
Phone No : -
Mobile No: 9827996191

Email ID : veank_chaturvedi@yahoo.co.in

Qualification Details (as on 11.04.2011):

Exam Passed Subject/Stream Year of Passing % of Marks

Graduation BE IN ELEX ENGG 2011 7.10

Working Knowledge of MS Office : YES

Other Details :

Would You like to undergo Pre-Exam Training (SC/ST/Minority

YES
Community/ Ex-Servicemen/ Physically Challenged) :
If Yes Centre for Training : Bhopal

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 New Delhi and courts/ Tribunal/ forums at New Delhi 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: 01-05-2011 Signature of Applicant

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