Tripura Gramin Bank Application for Recruitment of Officer Scale I & Office Assistant(Multipurpose) in Tripura Gramin Bank APPLICATION

PRINT-OUT NEED NOT BE SENT TO THE BANK Last Modified On : -No.Of Times Modified : 0 13031 Registration No. : Post : Post Code : Full Name : Category : Person With Disability : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe : 13018 Office Assistant 02 Tanusree Majumdar GENERAL No ----

Whether you belong to No Religious Minority Community : Religion to which you belong: Others: Domiciled in Kashmir Division: 5 years of service in RRBs: Ex-Serviceman : Total Period of Service : (in Months) Disabled Ex-Serviceman (DISXS) : Dependent Ex-Serviceman (DXS) : Nationality : Centre of Examination : Centre code : --No No No -No No Indian Agartala 11

Application Fee/ Postal Charges Details : Journal No : Branch Name : Branch Code: TR/2259 ABHOY NAGAR 8004

Deposit Date : Personal Details : Date of Birth : Gender : Husband's Name / Father's Name : Address for Correspondence :

24/05/2011

Amount :

400

12/07/1983 Female Lt Dipak Chandra Majumder C/O: Maya Rani Majumdar Vill/PO:North Jolaibari Near Post Office,Majumdar Para South Tripura Tripura C/O: Maya Rani Majumdar Vill/PO:North Jolaibari Near Post Office,Majumdar Para South Tripura Tripura

Age completed as on 01.04.2011 :

27

Mother's Name :

Maya Rani Majumdar

District : State : Permanent Address :

Pin :

799141

District State : Contact Details: Phone No : Email ID :

Pin :

799141

tanusree.agt@gmail.com

Mobile No :

8794351734

Qualification Details(as on 01.04.2011): Exams Passed Graduation Post Graduation Others Knowledge of Computers Skill : Details of computer Knowledge : Yes One Year Diploma Caurse Com. Name of the Course / Degree Others Year Of Passing 2005 % of Marks 43

Knowledge of the local language of the State / Union Territory for which he / she is applying Languages Known Bengali English Read Yes Yes Write Yes Yes Speak Yes Yes

Pre-Examination Training : Centre for Pre-Examination Training :

No No

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 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 or claims or disputes arising out of application or out of said advertisement can be instituted by me only at Agartala 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: 24/05/2011 Signature of Applicant: Name :Tanusree Majumdar Note: Please retain your registration No. Password emailed to you and copy of printout carefully for further reference. Please DO NOT SEND application print-out to the Bank. Please retain your Registration No. and Password carefully for future reference.