APPLICATION FORM The Director, Institute of Banking Personnel Selection P.B.No.8591, Kandivali (East), Mumbai-400101 With Ref.

To Punjab National Bank advertisement, I submit my application on prescribed format. 1. Post applied for ________________________ 2. Indicate Category to which you Category SC ST OBC Others belong by marking Tick in the appropriate Box 3. In case of SC/ST/OBC candidate a) Name of the Caste_________________________________________________________ b) Name of the State to which you belong________________________________________ c) I belong to SC/ST/OBC Category and I am Yes No Enclosing an attested Photostat copy of the prescribed certificate. 4. Name (Mr./Mrs./Km.) ________________________________________________________ (In Block Letters) 5. Correspondence address (In Block letters)

PIN 6. Permanent address (In Block letters)

PIN 7. Date of Birth: (Age as on 01/01/2002) D D M M Y Y ___________________Year_____________________Month 8. Place of Birth: Town________________Distt__________________State____________________ 9. Sex: Male_________________________Female__________________________________ 10. Fathers Name ______________________________________________ 11. Age relaxation claimed, if any: Yes No (Specify basis and enclose relevant certificate) Please mark tick 12.a) Are you an Ex-Serviceman? Yes No b) Are you a candidate who had ordinarily been domiciled in Kashmir division of the state of Yes No J&K during the period of 01.01.80 to 31.12.89

d) If you are PH Candidate, please mention percentage of Yes No disability and category of disability (Visually Handicapped/ Deaf/ Mute/ Orthopaedically Handicapped). Please enclose Photostat copy of Disability certificate from authorized Medical Board. 13. Educational Qualification (As on the date of application, Matriculation /SSLC onwards): Examination Name of the Subjects studies Date, Month & Percentage Passed Institution/ in detail Year passing of aggregate University marks

14. Particulars of Post Qualification Experience including the Present Occupation/job (as on the date of application) Name of Designation Period of Length of Nature of Remarks employer(s) etc. service service duties (reasons and the nature and performed in for details of activities detail leaving carried out by the service) From To employers Years/Month 1 2 3 4 5 6 7

15. Details of Application Fee: Demand Draft No. ________________ Dated _______________ Amt.________________ Name of the Bank ______________________________________ 16. Centre opted: Please tick name of one Centre opted in the Box: S.No. Centre Box Delhi Kolkata Mumbai Chennai Bangalore Lucknow Bhopal Patna Chandigarh Jaipur 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

17.Any other information _______________________________________________ Declaration I here by declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being hound false or incorrect at any stage or not satisfying the eligibility criteria according to requirements of the relative advertisement, my candidature/appointment is liable to be canceled/terminated. I am willing to serve anywhere in India. I agree that bank has the right to transfer me to any part of the country at its discretion. I here by agree that any legal proceedings in respect of any matter(s) or claims or disputes arising out of this application and/or out of said advertisement can be instituted by me only in NCT of Delhi and Courts/Tribunal/Forums at NCT of Delhi 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: Signature of the candidate