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ON-LINE APPLICATION FOR BANK OF BARODA CLERKS RECRUITMENT PROJECT

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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 # : 3631117
Full Name : Mr Tiwari Rupesh Ashokkumar
Category : GENERAL
If Person with Disability : NO
Type of Disability : -- Percentage of Disability : --

Do you intend to use the services of a scribe( only for VH and

--
OH candidates whose writing speed is affected by cerebral palsy) :
Are you candidate who had ordinarily been domiciled in Kashmir
NO
Division of the State of J&K during the period 1-1-1980 to 31-12-1989?
Are you Children/family members of those who died in 1984 riots NO
Whether you belong to Religious Minority Community NO
Minority Religion : --
Are you an Ex-Serviceman (Including ECO/SSCO)? NO
Are you a disabled Ex-Serviceman (DISXS) NO
Are you a dependent of an Ex-Serviceman (DXS) NO

Have you passed in Service (Departmental) Examination which is equivalent

NO
to Civil Examination not below the rank of HSC?
Are you seeking relaxation under widow/divorced women/women judicially/
NO
Separated from their husbands and who are not re-married?

District Preference for Posting :

District Preference 1 : Rajkot
District Preference 2 : Jamnagar
District Preference 3 : Ahmedabad

Are you an employee of Bank of Baroda : NO

If yes,E. C. No :

Nationality : Indian
State / Union Territory for which you are applying : Gujarat

State / UT code : 20
Centre of Examination : RAJK0T

Centre code : 15

Application Fee / Postal Charges Details :

Transaction ID : M491386

Branch Name : Phagwara

Branch Code No : 0810

Deposit Date : 07-02-2011

Amount : 200

Personal Details :
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Date of Birth : August 08,1985 Age as on on 01.01.2011. : 25

Gender : MALE
Father's Name/ Husband's Name : Mr.Ashok.s.Tiwari

Mother's Name : Mrs.Snehlata Tiwari

Email ID : m.ricky8@gmail.com

Address for Correspondence : Ashok Nivas Plot No 6

Asopalav Park GIDC Road

Porbandar
District Porbandar

State : GUJARAT

Pin : 360577
Permanent Address : Ashok Nivas Plot No 6

Asopalav Park GIDC Road

Porbandar

District Porbandar
State : GUJARAT

Pin : 360577

Contact Details:
Phone No : -

Mobile No: 9780047876

Qualification Details (as on 01.01.2011):

Exams Passed Subject/Stream University / Board Year Of Passing % of Marks

HSC / Equivalent : Science CBSE 23-05-2002 58.00

Graduation : Electronics Sardar p university 03-06-2005 68.00

Diploma in Banking : NO

Possess certificate in computer literacy : YES

Post qualification work experience details as on 01.01.2011 (Start from Present Employer) :

No Experience

Other Details :

Whether desirous of taking Pre-Exam Training

--
(SC/ST/PWD/Minority Community) :
If Yes Centre for Training : --

Languages Known Read Write Speak

English YES YES YES

Hindi YES YES YES

Gujrati YES YES YES

DECLARATION:
I hereby certify that the information furnished above 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/services 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 the advised criteria in respect of age, educational
qualification and experience, 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.
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I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of this application or out of said advertisement
can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai only, shall have sole and exclusive jurisdiction to try any cause/dispute. I
undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank.

Place:
Date: 08-02-2011 Signature of Applicant

Tiwari Rupesh Ashokkumar

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