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13034

To,
Post Box No. 8229
Dahisar - (East)
Mumbai 400 068
Please paste your
recent passport
size photograph
and sign across it.
Registration #: 15043
Please retain
atleast 5 copies
with you for
subsequent use.
Full Name : SHRIHARI RAGHAVENDRARAO DESAI
Post Applied For OFFICERS IN JUNIOR MANAGEMENT GRADE SCALE-I
Post Code 2
Category GENERAL
If Physically Challenged: NO
Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989 : NO
Whether you belong to Religious Minority Community? : NO
Are you an Ex-Serviceman? : NO
Are you a Disabled Ex-Serviceman (DISXS)?: NO
Are you a Dependent of an Ex-Serviceman killed in action (DXS)? : NO
Are you seeking relaxation under window / divorced women / women judicially Separated from their husbands
NO
and who are not re-married?:
Nationality: INDIAN
Examination Center: BIJAPUR Center Code : 13

Application Fee/ Postal Charges Details:-

Name of Issuing Bank : SBM
Place of Issue : BAGALKOT
Demand Draft/Pay Order No. 396416
Date of Issue : 06/01/2011
Amount : 200

Personal Details:
Date Of Birth : 04/06/1986
Age completed as on 01.09.2010 : 24
Gender : MALE
Husbands / Fathers Name: RAGHAVENDRARAO K DESAI
Mothers Name: HEERABAI R DESAI
Address for Correspondence: C/O V S DESAI BHAVANI KRUPA PLOT NO
PRASANNA VENKATA BADAVANE
SECTOR NO 57 NAVANAGAR BAGALKOT
District BAGALKOT
State: KARNATAKA Pincode: 587103
Permanent Address: C/O V S DESAI BHAVANI KRUPA PLOT NO
PRASANNA VENKATA BADAVANE
SECTOR NO 57 NAVANAGAR BAGALKOT
District BAGALKOT
State: KARNATAKA Pincode: 587103

Contact Details:
E-mail ID: shrihari_r_desai@yahoo.co.in
Mobile No: 9739869083

Qualification Details(as on 30.09.2010):

Exams Passed Subjects/Streams Year Of Passing % Of Marks Class / Grade
Graduation : B.E MECHANICAL 2007 62.13 FIRST CLASS
Post Graduation : M.B.A 2009 70.87 FIRST CLASS
Working Knowledge of Computers: YES
Details of Computer Knowledge :MS OFFICE

Post Qualification work experience details (Start from present Employer) :

Total Experience(in Months): null

Other Details:
Would You like to undergo Pre-Exam Training (SC/ST): NO
Languages Known Read Write Speak
KANNADA YES YES YES
ENGLISH YES YES YES
HINDI YES YES YES
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 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 Dharwad and courts/ Tribunal/ forums at Dharwad 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:c
Date: 08/01/2011cSignature of Applicant:c
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