Professional Documents
Culture Documents
Human Resources
Mumbai–400 005
Attestation Form
Warning
1.The furnishing of false information or suppression of any factual information in the Attestation Form would be
a disqualification and is likely to render the candidates unfit for employment in the Bank.
2.If detained, convicted, debarred, etc. subsequent to the completion and submission of this form, the details
should be communicated immediately to the Bank or the authority to whom the attestation from has been
sent earlier, the case may be, failing which it will be deemed to be a suppression of factual information.
3.If the fact that false information has been furnished or that there has been suppression of any factual
information in the attestation form comes to notice at any time during the service of a person, his services
would be liable to be terminated without any notice or compensation in lieu thereof.
Note: Please fill in the entire form in capital letters appropriately; write “Not Applicable” in the columns if
the entry is not applicable to you. If any column is left unfilled this form is considered “incomplete and not
valid”.
1. Name in full (in block capitals) with aliases, if any Affix you recent
Photograph and
(Please indicate if you have added or dropped at any stage any part of your name or surname.) sign across the
photograph
Surname (6cm x 7cm)
First name
Middle name
2. Present address in full (i.e. Village, Tehsil and District or House Number, Lane/Street/Road and Town).
Address
District
State Pin
Telephone
3. (a) Home address/Permanent in full (i.e. Village, Tehsil and District or House Number, Lane/ Street/
Road and Town and name of District Head quarters.
Address
District
State Pin
Telephone
(b) If originally a resident of Pakistan, the address in that country and the date of migration to Indian Union.
Address
District
State Pin
Telephone
From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No
From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No
From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No
From:(DD/MM/YYYY) From:(DD/MM/YYYY)
Address
District
Name of District Headquarters
State
PIN Telephone No
6 Nationality
10. Educational qualification showing places of education with years in Schools and Colleges since 15th year of age
Period
Name of School/College with full address Examination passed
Date of Joining Date of Leaving
11. (a) If you have, at any time, been employed give details :
Designation/Post Held Reason for leaving
Period (MM/YY) Full address of the firm or institution
or Job Description pervious service
From To
12. (a) Have you ever been arrested, prosecuted, kept under
detention or bound down/fined, convicted by a court of law for
any offence, or debarred/disqualified by any Public Service
Commission or any institution from appearing at its
examination/selection or debarred from any examination,
rusticated by any University or any other educational
Authority/institution?
(b) Is any case pending against you in any court of law,
University or any other educational authority/institution at the
time of filling up this attestation form?
(If the answer to (a) or (b) is 'Yes', full particulars of the case, arrest, detention, fine, conviction, sentence etc., and
the nature of the case pending in the Court/University/Educational authority etc., at any time of filing up this form
should be given.)
13. Name and addresses of two responsible persons of your locality or two references to whom you are known.
District
State Pin
Telephone
District
State Pin
Telephone
………………………………………………………………………………………………………………………………………………………………………………………………
I certify that the foregoing information is correct and complete to the best of my knowledge and belief. I am
not aware of any circumstances, which might impair my fitness for employment under Government/Bank.
Date :
Place :
(Signature of candidate)
Affix signed
passport
size
Photograph
Signature ………………………………………………………..
Place:
Date:
………………………………………………………………………………………………………………………………………………………………………………………………
TO BE FILLED BY THE OFFICE
Name, designation and address of the appointing authority: IDBI Bank Ltd.