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APPLICATION FORMAT

APPLICATION FOR THE POST OF SECURITY OFFICER IN UNITED BANK OF INDIA

(Fill all columns in legible capital letters & use 21 cms x 34 cms size paper)

General Manager,(Resources Management)United Bank of India,Head Office,11, Hemanta Basu Sarani,Kolkata 700 001 (W.B.)

I hereby submit my application for the above post in the prescribed format.

1. FULL NAME (IN BLOCK LETTERS) (Leave one space blank between twoparts of your names)Mr./Mrs.

2. ADDRESS FOR CORRESPONDENCE

3. (i) Indicate Category to which you belong to by Ticking the appropriate box

SC ST OBC GENERAL

(Please attach attested copy of Certificate wherever necessary)

(ii) Persons with Disabilities please tick the appropriate box.Percentage of disability..

(Please attach attested Photostat copy of Medical Certificateissued by Medical Board at District Level)

Do you intend to use the service of a Scribe?

4. Date of Birth (As per School leaving Certificate SSLC)Date_______ Month_____ Year________.

Age as on 01.01.2009 ____Years____ Months______

Contd.2

PLEASE AFFIXYOUR RECENTPHOTOGRAPH

AND SIGNACROSS

VH HI OH

YES NO

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//2//5. Details of Application fee.

Name &address of theissuing Bank

Name &address of thedrawee Bank

Date of issue DD/Bank PayOrder No.

Amount

[Demand Drafts / Pay Orders may be drawn in favour ofUnited Bank of India Specialist Officer Recruitment Project 2008]

[Fees for the post is Rs.400/- for General and OB C candidates and Rs.50/- (towardspostal charges only) for SC/ST/VH/HI/OH candidates. Payment by Cash, Cheque,Postal Stamps, Money Order etc. will not be accepted and such applications will berejected]

6. CONTACT NO.: TELEPHONE NO. (with STD code):_________FAX_______________ E-MAIL______________ MOBILE NO.:______________

7. GENDER : Tick in the appropriate box

MALE FEMALE

8. Please specify your

(i) Date of Discharge:____________Rank at present / last held A) Acting__________w.e.f.______________

B) Substantive______w.e.f.______________

(ii) Are you a candidate who had ordinarily been domiciled in Kashmir Divisionof the State of J&K during the period of 01.01.1980 to 31.12.1989?

(iii) Whether you belong to Minority community?(Tick in the appropriate box)If yes, please state the religion:

______________(iv) In case of SC/ST/OBC Candidate: ____________

(a) Name of the Caste / Tribe / Class: _________

(b) Name of the State to which you belong: _____

9. FATHERS / HUSBANDS NAME: (IN BLOCK LETTERS)

10. NATIONALITY: ______________

11. PLACE OF BIRTH: Place____________Dist:_____________State_____________

Contd.3

YES NO

YES NO

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12. PERMANENT ADDRESS (IN BLOCK LETTERS):

13. Educational and Professional Qualifications:(a) Details of Graduation / Post Graduation as per the eligibility criteria prescribed

for the posts concerned in the advertisement (As on the date of application)If all the information in these boxes is not provided, the application will be rejected.

Particulars Name of the Degreeand Discipline

Class / Division Percentage of aggregate marks

Graduation

Post Graduation

b) Details of Education (10th standard onwards)

Examinationpassed

Name of theInstitution/University

Subjectsstudied indetail

Date,Month,year ofpassing

Percentageof aggregatemarks

Class /Division

14. Particulars of Post Qualification Experience including the Present Occupation / Job(As on the date of application):

Name of the

employer (s) /

firm etc. and

the nature and

details ofactivities

carried out by

the employer

Designationand rank, ifany

Period of Service

From To

Length ofServiceYrs.

Months/days

Nature ofdutiesperformed

in detail

Remarks(Reasonsfor leaving

services)

Contd.4.

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15. Languages known:

Sl.No. Language Read* Write* Speak*

*(Mark X in the appropriate box)

BEFORE MAILING APPLICATION PLEASE CHECK THAT YOU HAVE CORRECTLYMENTIONED.

1. Category / Sub-category and have enclosed copies of necessary certificatesfor SC / ST/ OBC / VH / HI / OH / XS candidates.

2. Details regarding fees (Demand Draft / Pay Order).

3. Address for correspondence.

4. Details for claiming relaxation in age and the relevant certificate isenclosed.

DECLARATION: I hereby declare that all statements made in this application are true,

complete and correct to the best of my knowledge and belief. I understand in the eventof any information belong found false or incorrect at any stage or not satisfying theeligibility criteria according to the requirements of the relative advertisement, mycandidature / appointment is liable to be cancelled / terminated. I am willing to serveany where in India. I agree that Bank has the right to transfer me to any part of thecountry at its discretion. I hereby agree that any legal proceedings in respect of anymatter (s) or claims or disputes arising out of this application and / or out of saidadvertisement can be instituted by me only at Kolkata and Courts / Tribunals / Forumsat Kolkata only shall have sole and exclusive jurisdiction to try the cause / dispute. Iundertake to abide by all the terms & conditions mentioned in the advertisement givenby the Bank.

PLACE:

DATE: SIGNATURE OF CANDIDATE