Madhya Bharat Gramin Bank

25041
Registration #: 27853 Please paste your
Full Name : PRIYANKA TIWARI recent passport
size photograph
Post Applied For OFFICE ASSISTANTS-GROUP-B and sign across it.
Post Code 2 Please retain
atleast 5 copies
Category GENERAL with you for
If Physically Challenged: NO subsequent use.
Whether domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989 : NO
Are you an Ex-Serviceman? : NO
Are you a Employees who have completed 5 years of service in RRBs ?: NO
Are you seeking relaxation under window / divorced women / women judicially Separated from their
NO
husbands and who are not re-married?:
Domicile of Madhya Pradesh: YES
Nationality: INDIAN
Center of Examination : SAGAR Center Code : 12
Application Fee/ Postal Charges Details:-
Payment In : STATE BANK OF INDIA
Transaction ID : 9931377
Branch Name : SBI GOPALGANJ SAGAR
Branch Code: 07214
Deposit Date : 16/11/2010
Amount : 300
Personal Details:
Date Of Birth : 17/06/1989
Age completed as on 01.09.2010 : 21
Gender : FEMALE
Husbands / Fathers Name: RAMESHWAR PRASAD TIWARI
Mothers Name: ARCHANA TIWARI
Contact Details:
E-mail ID: rptiwariji@yahoo.in
Address for Correspondence: PRIYANKA TIWARI D/O RAMESHWAR
PRASAD TIWARI NEAR YASODA
MARRIAGEHALL PAGARA ROAD
District SUBHAS NAGAR SAGAR
State: MADHYA PRADESH Pincode: 470002
Permanent Address: PRIYANKA TIWARI D/O RAMESHWAR
PRASAD TIWARI NEAR YASODA
MARRIAGEHALL PAGARA ROAD
District SUBHAS NAGAR SAGAR
State: MADHYA PRADESH Pincode: 470002
STD Code. 0758 Phone No. 247698
Mobile No: 9301414624
Qualification Details(as on 01.09.2010):
Exams Passed Subjects/Streams Year Of Passing % Of Marks Class/Grade
Graduation : B.SC 2009 58.59 SECOND
Working Knowledge of Computers: YES
Languages Known Read Write Speak
HINDI YES YES YES
ENGLISH YES YES YES
SANSKRIT YES YES YES
Other Details:
Would You like to undergo Pre-Exam Training (SC/ST): NO
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/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.

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 Madhya Pradesh only, shall have sole and exclusive jurisdiction
to try any cause/dispute. I undertake to abide by all the terms and conditions in the advertisement given by the Bank.
Place:
Date: 16/11/2010 Signature of Applicant:

PRIYANKA TIWARI
Please retain your Registration No. and Password emailed to you carefully for further reference.
NOTE: APPLICATION PRINT-OUT NEED NOT BE SENT TO THE BANK