VANANCHAL GRAMIN BANK(Sponsored by: State Bank of India)Head Office, Dumka (Jharkhand)

Phone No. - (06434) 222401, 240743, 236170(Per.) Fax No. - (06434) 222401Website:- www.vananchalgraminbankcom. E-mail:-vananchaldumka@rediffmail.com

HO/HR/ /14-15 Date :-Roll No .

SPECIMEN

Dear Sir / Madam,Vananchal Gramin Bank Recruitment Project-2013Recruitment Of Officer MMGS-Ili/ MMGS-II/JMGS-I (Group - 'A')Office Assistant (Group - 'B')Interview Date .We are pleased to inform that you have been short listed for interview on the basis of marks obtainedby you in CWE for RRBsconducted by IBPSin September 2013:-

1. The venue for above interview is as underVananchal Gramin Bank (H.D.)Municipality chowk, Dumka(Telephone No. 06434 236170)

2. Please report on " at 8.30 A.MI12.30 P.M.sharp with the hard copy (printout) ofthe filled in application form with same photograph duly pasted / all certificates/ marksSheets / testimonials, in original & photocopies from Matriculation onwards.

3. Please bring with you original copy of Challan or proof of fee paid by you.4. The ST/SC/OBC (OBC candidates are required to submit non- creamy layer certificate)

candidates must bring cast certificates in original with its photocopies issued by CompetentAuthority.

5. You should also bring "Domicile Certificate IAddress proof" issued by a competent Authorityin original with photocopy.

6. Certificate of experience certificate in respect of Previous / Present employment, if any andNOC from your present employer.

7. The enclosed "BIO-DATA" form should be submitted before interview Board duly filled inalongwith all supporting documents otherwise you will not be allowed for interview.

8. Please note that no travelling and other expenses will be paid in this regard.Yours faithfully

General Manager (Administration)Enel: -As stated above

c.rGJhrM OJ I Jfl 01 hVANANCHAl GRAMIN BANK

Head Office: Shiv-Palace, Nagar Palika Chowk, Durnka (Jharkhand)~n!{ft Cf)T0TWlCOVl 'q;ct ~ W

CANDIDATE'SBIO-DATA-CUM·ATTESTATIONFORM(~ mcrtll'i"I'i':fCh ~ cfi 11!{~ 1:fiTlf \3N-fr ~{~81fq~.qt)

(Please fill in theform in you own handwriting carefully)

m~cfjfW:r~ / Centre for Interview: Vananchal Gramin Bank H,O., DUMKA6ilful"{iCf) / Roll No, :~Cfif'1rT / NameofPost:m~~~cm~:~/~Choice of Language for Interview: Hindi / English

Paste a recent Ipassport size photographhere and sign across it in I

full with date

1. (Cf)) ~ 'l'Ff ~ i3WU ~ :(a) Name in full, in block letters :

ml~t+rot~.Shri/Smt./Kum.

(@) ~ ~: fclc;II~{1/ 61fc1c;H~{1(b) Marital Status: Married / Unmarried

(<9') 01.07.2013 ~~(b) Ageason01.07.2013

I I I~/Date

eNYear

I ]: I.~ I Month

~Month

[ ICI1if / Year

2. (Cf)) YR"~(a) Date of Birth

(1]") \JP1 qif ~(c) Place ofBirth

fvImDistrict

"{l\R:fState

(q) ~ ~ ~ \JfQT cfj \3{N f.rcffift l(d) District and State to which you belong:

3. (Cfi) {i~(@

(a) Nationality:(&) qtf(b) Religion:

4. (Cf)) f1«rr;t@r qif 'l'Ff 'CfCi" clFRIl tI / ~(!J Father's / Husband's name andoccupation / profession / designation(~) l1Tq)f;wr (aFHM /~, ~~~nIT) :(b) Mother's name: (Occupation / designation, if any)

5. (Cf)) ~ (4t"i'tfilfl ~~~qif~~(a) Category (Tick the appropriate box)

(<9') ~\iflftr / iJlj~Q \J11\J1(R! I i3Bf~q<f~l3uf1c::q(~-/ \J11\J1(R1 ~q)T'l'Ff~ - -

(b) IFSC/ST/OBC state the name of 'CASTE/TRIBE/COMMUNITY

(1]") <Mi31Nfclq)(1Ii~(~m~4~fil'ct \3U<mif~q)T~~~ ~fclt{)(1Ij~( <n"~ fclCfj(i\i~1~ J3{q'Uf fclf6(i\j~1

(c) Ifyou are handicapped, please also tick appropriate box.i.e.OHorVHorHI

SC ST GEN OBe

I I~~. 0 ~m.D CJ

OH VH HI

(f.T) ~ i31N ~~ -ij- fclCb(1lj1(lm~ ~ fclf6(11jJ({1(qif ~~~(d) Ifyou are a Physically Handicapped person, please give details of your handicap.

6. (tfJ) ~i31N5I\'Q(qRfu/~/Pl~trq{1~mm~~~(a) ifyou are a repatriate / migrant / displaced person, give particulars:

(~) <Mi31N~~~m~Cbl<f!!Rffi l~q(PI~ rtt~qif~~(b) IfEx-serviceman, Please give date of dlscnare / retirement

1

7. (Cf;) ll"Ri'qflU(a) Mother Tongue:(@) ~<5~~'qflU\3ifCf)Tw-r (~q)f(~m~(b) Knowledge oflanguages Othe; than English (Indicate by a C'./J tick Mark:) :

'qflULanguage Speak1.

2.

3.

8. (C{i) ~!~~:(a) Educational Qualification:

~~~Cf)T ~I i3IClfq I Period ~m ~~

~~ ~~ -qjT~~ ~ ~<tf ~~ -Examination Indicate College/ t Examining Principal, mr . Class &Passed .Faculty Arts/ School

QCf) body Subjects No.of PercentageScience/ Comm. From To .. attempts Rank of marks

1 2 3 4 5 6 7 8 9

C{imClass X

C{imClass XII

~Graduation

~mq;h1(Post Graduation

~(~~)Other (Specify)

9. ~~/~/t§1?\~41q)f~ •Particulars of Prizes/medals/scholarships obtained:

10. (C{i) -wr~ qlQ.4t6~<H 1fu4ICfi<'1I<D<{iffclcR"or,~~1WT~~,~~~~<W4m:

(a) Particulars of sports and other extra-curricular activitiesin which you have participated, Credits &Distinctions obta:nined:

(@) i3lfTi~~41~~~(b) Hobbies&otherinterests:

11. ~ ~ ~ ~~ ~ 1"Sffu~ <{iffcrcr\urParticulars of any special qualification / training in Banking

12. (C{i) ~~~<5~<{if~(a) Particulars of present and previous employment:

~<{if~t{CtllQT i3IClfq I Period . l{GQlIT 'fiIl1 'qif ~'qif ~~ ~'fiT~Name & Address of t ~ ~ Total Emoluments

Reasons forQcl) Position and Place of I ~it aiQit~employer From To Nature of Duties Postiong Starting Last Drawn leaving

hO"~~~(<!f) ~ f'l41iJ1Cfi q5f ~ (mcortt / ~ ~ I *114vtf'lCfi ~ I f.rvft ~)

~I ~(b) Status of present employer (Govt. / Semi-Govt. / Pub. / Pvt. Sector) :.~-

2

13. q:;r~~~~ (~)w:Present address in full for communication:

13.~mtrnT:Permanent address in full:

ff.T.PIN CODE = ftr-f~

PIN CODE =~~Telephone No./M.No.

~MTelephone No./M.No ..

15. iRW.nem ~ \ifQf BTN fuffl t{f;:f ~ c6"m ~ eN ~ ~ ~ Qq; ~ it: ,Particulars of places where you have resided for more than 1year during the last 5 years:

~. f.rcrrn ~ q)f lU l{QT

~ cmtlf ~ f~;tPTq~ CfiT1;1CI) , ~~

From To Residential address in full District: Head Quartet of the placementioned in the left column

.'.

16.,~~;q1~1<'1~ ~~~~~c6~I3I~(llii\"1 r~fGUS/c{!~Rt<i!i) q)T~~iTm~~.Particulars of anyprosecuttou/ detention/fineconviction sentence against you awarded by any court oflaw for offence.. .

17.~~;qI~I(il~ ~i3TfC1'c6~~llPR'IT ~/i3f-<ffcfflt<rml3lT~~~1"tt~~~W~)fcjill(41'1mm~~.Particulars of case pending against you in any court oflawincluding case (s) for non-payment of any loan from Banks/Financial Institutions:

18.~~~.~, tRT~m~~'~"Cfft~~~~~iT /~~ctrm, m~fcwur.Particulars of disqualification/ debarment by any ServiceCommission, examining bodyat their selection/examination:

19. i3lfCfC6~~~Pt<itii\q; (~)mr~:'~~fcmlfq / rqill(lt:ft'1I31§tIl~11{'1ct,.q;14cu~·cprfctcRur,~ ~ ~ q~HRt tRT~~~ tf\

m~lT4Tmm~'4T~~.

Particulars of any case (s) of disciplinary action institutedfpending against you byyour present or previousemployer (s). Please also state whether you were debarredfrom appearing in any promotional examination.

20. ~mtnullulq?\l Cf)f·fcrcRur 1Particulars of character certificates enclosed 2

3

3

21.~Slra~trlt~cf;;wrtClFH1(~~~(-m~~mt~m~m)N ccupation and addresses of two respectable references (known to you but not related)i ame,o ..

~~ ';fIlf qwAddress51.No. Name

1.

2.

22.l3RffcrcRvr\ifT~cf;~~ m~m:Additional particulars, if any, which may beof use to the Bank:

~~Cf)W /~{~~~irtt~\lj11Cbla ~~cf;~~, ~Cf~l. ~~~'4T~.~~ -mt\llT~~~~cf;~~~if~~mm.~<JQift~qmrr/qmfTt~~$r~d\ftlPt~'11961cf;~~f~ftfCf;~~~~cf;Wifri1ft~~~lJ<rr! I

~ if{zm ~ ~ lJ(IT~ llmf <IT~ qmr \Il1QT l am: 1~"Cffilf ~ ~~ cll~f4CbQait q)f~ \ifAT~rtt~iftfffi"~lm~cm~~, ~cf;mtcr., ~'4t1WRiJTm-, ~mcpfd\ftlCbI(~.. I certify that the. particulars furnished above ~re true, correc~ and ~om~lete ~o the bes~lof myknowledge and behef. I am not aware of any CIrcumstance whlch might imparr my fitness foremploymentunderthe Bank. .

Further, I declare that I have never been convicted for any dowry offence under the DowryProhibition Act, 1961, or any criminal offence under any other law.

In case the particulars submitted by me are found to be false or not true and;' or suppression ofmaterial' facts by me while submitting the form is revealed ata latter date, the Bank shall have the rightto cancel the appointment including the offer for appointment, as the case may be. The-above detailsare submitted in reference to Vananchal Gramin Bank Recruitment Project "2010" & my applicationSUbmitted earlier.

~Date :m Place:

~~c6~~f.m'Right Thumb Impression

~q;r~~Signature of the Candidate

~.3ilWlT.~IDENTITY CERTiF1CATE

~~\iffiiTl~~.l3ft/~~ ~/.~/.6ITOO. CertifythatI have known Shri j Smt.jKum. . sonjwifejdat.ghterof

.gft . q;f~. ~ lJtAl~\ifRm~tOO:~OiHCblaShri for the past __ years __ monthj s and that to the besfofrny~~cf;~~W~lJ(IT~~~~ I . .knowledge and belief the particulars furnished above by him/her are correct.

!

m- Place:~~ Signature:

~ Designation:~Date :

W Address:SEAL

~ c6~ ~ I FOR OFFICE USE ONLY(1) m131!;tb1( ~flf41rBlQmq)f~:

Date ofappeartng tn interview:

(2) ~/5Pilolq3{fq;r~ J;!ft"/~ ~

Eltgtbltty /Certificates verified by: ShrijSmt. Designation: _

(3) ~~5WQf4~~(~:Deflciencies and Discrepancies found:

4

- -------

\3l1S1)¥1 i<f1 ;Roll No.:

~;Post:

"WI" ~Name:

~ctt~List of Enclosures

• BW«f~ -mrttiT~~~fctm ~~~

Enclosed Un EnclosedTick the appropritate box.

CJ CJ1. ~~~~tp.;Tc6r~

Hard copy offilled online application.

CJ CJ2. ~COTm~~-q?fCOT~proof of Age Name of Document.

CJ CJ3. Cflm 12 eft <:ITfg'<'11liI COT0iCfl~IRitCflrMark-sheet of 12th standard or Diploma.

4. Cflm 12 eft <:IT~'<'11111COT~ q?f LJ CJCertificate of 12th standard or Diploma.

CJ CJJ 5. ~ \3lq:j ~ IRitCfli (~~ '@1-« ~ en{ ~ m.-q;.f<ift.t.;mfi.)I Gradution Mark-sheet (Please specify B.A./B.5c. etc.).;

~fumg+ffUT-q?f (~~'@1~~cg~m.-q;.fifi.~.) LJ CJJ 6.Gradution Degree (Please specify B.A./B.5c. etc.).

CJ CJ7. 'M Idcb)'tH \3lq:j dl RitCfli (~~ '@1~ ~ tit ~ -q;+r.-q;.;q::r.~.)Post Gradution Mark-sheet (Please specify M.A./M.Sc. etc.).

8. 'Mldcb)'d{&m~-q?T (~~~-«~qft~-q:r.-q;.;q::r.~.) CJ CJPostGradution Degree Certificate (Please specify M.A./M.5c. etc.).

9. m / ~ ~ g+ffUT-q?f~ 'ffi1l m CJ CJTWO/Three Character Certificate as applicable.

10. CflU<:[2:{~~ COTg+ffUT-q?T CJ CJCertificate of computer Proficiency.

11. \3{j;~.J~d ~f\iA"-\Jfl"fu/\3T.fq.q. g+ffUT-q?f CJ CJSC/ST/OBC Certificate.

12. ~ fTllj)\il CfI'~ ~ g+ffUT-tpf CJ CJNo Objection Certificate from Present Employer.

13. ~ '!ll1"fOT-tpf .C] CJExperience Certificate,

14. fcl ~fCR1'!ll1"fOT-q?T ., CJ CJDischarge Certificate.

15. ~ :~ft.tfi.~.GRr ~ \3tcn ';1/RitCfli<tTgfu (qt[m 2013) CJ CJCopy & Score Card issued by IBPS.(Exam 2013) .

16. ~[%CfI<'1~~~~-q?T CJ CJCertificate regarding Medical Category

17. 0PFi'I'''"1dIQ (~~'@1~~cg) CJ CJOther qualification (Please specify).

18. ql~4¢f)11wrm \3"Pl~ -« ~ g+ffUT-tpf (~~ .~.~ ~ qft) CJ CJCertificate regarding extra curricular activity (Please specify).

19. fTlCjI~fl<q'!ll1"fOT-Lf?[ "ff~ ~ GRr wmflffi COT~ CJ CJDomicile Certificate issued by Competent Authority/Address Proof.

20. ~/~ ~ cfig+ffUT<tT~ CJ LJ·Original copyofChalian/Proofoffee payment. .\ :.

~L.l.'.\ "0.:I;': ,I -,t..,. v.tf.

',.:::r ~l"''1.~,i~ q:iT-mT~ -',-..:',.Signature of the Candidate

5

cr;:n~ OJIJft 0, ihf;VANANCHAL GRAMIN BAN K

Head Office: Shiv-Palace, Nagar palik~ Chowk, Dumka (Jharkhand)1J~T~lTCfiT \3-~ 'q:cf ~ ~

CANDIDATE'SBIO_DATA-CUM-ATTESTATIONFO.R~(

"cfC6 ~ ct lT~~ ~ 0T'RT t:\~R:lyq ~ .qt)~ -mcrtll'1I'i: • . . f 11 )

(Please fill in theform in you own handwntIng care u y

m~~cfj~~ / Centre for Interview: Vananchal Gramin Bank H,G., DUMKA

3\j)fuliiCfi / Roll No, :~"CfiT~ / Name of Post: .m~~~Cffi~:~/~ .' .Choice of Language for IntervIew: Htndi / EnglIsh

'J01 mMi·o3TT<!iR lOr ~

~i!~~,mmt Il~lI'miffitf(~

~'!."i~mllit:

Paste a recentpassport size photographhere and sign across it in

full with date

1. (Cfi) ~~~aT~~:(a) Name in full, in block letters:

m/~~.Shri/Smt./Kum.

(lS) ~ ~ : fcF4IRiQ / \-S1Fc1cuRi<l .(b) Marital Status: Married / Unmarned

D·I.~I Month'.Month

;. ~~j~~Birth I. I I~/Date

eNYear

("@") 01.07.2013 cmB1f(b) Ageason01.07.2013

(If)(c)

(tr)(d)

~District

~State

~q)f~Place ofBirth

~~~vr&c5\ilN~~District and State to which you belong:

eN / Year

3. (Cfi)

~;~(b)

\1&t\<Ol(j(Nationality:t.pfReligion:

4. (Cfi)

~~)(b)

ffirrlGfu q)f 'f!11 ~ ~(H{(4 / ~Father's / Husband's name andoccupation / profession j designationIiTcor'f!11 (~(HlI<Ol /~, ~wm-m) .Mother's name: (Occupation j designation, if any)

5. (q)) ~ (\IOll':i'IRrct i3WRf~~q)f~wm)(a) Category (Tick the appropriate box)

('&) ~\iflfu /l3Il~C1 \Jj1\JjIRl/i3Bf~crf~l3uf1~q«vITfu-j G11G1 IRl~ CfiT'f!11 ~ . .

(b) IFSC/STjOBCstatethenameof .CASTE/TRIBE/COMMUNITY

(If) ~i3lN[4C6~i~l~m~q~l~"ct i3Wrnit~CfiTm~~ ~ .fCI~~j~1en-~ FcIC6{i\i~( en-.grqar FclC6~i~(

(c) Ifyou are handicapped, please also tick appropriate box.Le.OHorVHorHI .

SC ST GEN OBC

[ ]~~. 0 ~ fcrcp.

D c=JOH VH HI

(tr) ~i3lN ~~~ FclC6~i·(lm~~fc!C6i.i1j~(j( q)ffcrcn:ur~cg(d) Ifyou are a Physically Handicapped person, please give details of your handicap.

6. (Cfi) ~ i3lN 5h'4IClRfu/ ~ / rq~(fq(j oWKl"& m ~ ~ a:(a) if you are a repatriate j migrant I displaced person, give particulars:

('&) ~i3lN~B~m~C6!4!!fiffi l{{qlP1"iRlc5T~CfiT~~(b) lfEx-serviceman, Please give date of dischare / retirement

1

----- --------

FORM OF CERI1FICATE TO BE PRODUCED BY OTHER BACKWARD CLASSESAPPLYING FOR APPOINTMENT TO POSTS UNDER THE

, GOVERMENT OF INDIA[£ERTIFICATE SHOULD BE ISSUED ON OR AFTER 01.04.20091

This is to certify that , 1

Son 0/ -', ofvillaqe _

District/Division in the _____________ State _

belongs to the - community which isrecognised as a backward class under the Government of India, Ministry of WelfareResolution No. 12011/68/93-BCC(C), dated 10th Sept..1993-published in the Gazette ofIndia Extraordinary Part] Section Jdated 13th Sept. 1993.

Shri and / or hisfamily ordinarilyresiders) in the District/Division of the--- State.

This is also to certify that he/she does not belong to thepersons/section (Creamy,Layer) mentioned in column 3of the Schedule to the Govermentof lndia, Department of Personnel & Training O.M. No. 36012/22/93 ~Estt. (SCTJ dated08.09.1993.

Date District MagistrateDeputy Commissioner etc.

Seal

NB

(a) The term 'ordinarily' used here will have the same meaning as in Section 20 ofthe Representation of the Peoples Act, 1950.

(b ) Where the certificates are issued by Gazetted Officers of the Union Governmentor State Govements, thet should be in the same fr~m but countersigned by theDistrict Magistrate or Deputy Commissioner (Certificates issued by GazettedOffi~e.rs and attested by District Magistrate/Deputy Commissioner are n~~.f,l'O'H

sufftcients). '/.* .•~>S' *,i

6 ' •.~~~