ANDHRA PRAGATHI GRAMEENA BANK

HEAD OFFICE :KADAPA

DIRECT RECRUITMENT PROJECT 2013 TO THE POST OF
OFFICER SCALE-I
The list of candidates selected for the post of Probationary Officer in Junior
Management Grade Scale-I is already placed in our Banks website. The
Appointment Orders to all the selected candidates, along with the
required certificates/proformae to be submitted by them, were sent to
the addresses furnished by the candidates, advising them to report at
Rural Banking Training Centre (RBTC), Andhra Pragathi Grameena Bank,
Ambedkar Road, Opp. Zilla Parishad, Anantapur-515001 on 01.04.2013
by 9.00 a.m. , without fail, for undergoing training from 01.04.2013 to
13.04.2013. The candidates who wish to accept the offer of appointment
shall
communicate
their
acceptance
by
sending
the
copy
of
ACKNOWLEDGEMENT OF THE CANDIDATE, which is enclosed to the
Appointment Letter, by fax to 08562-222017/244169 so as to reach us on or
before 28.03.2013. In the event of any candidate failing to report at the
training centre at Anantapur on 01.04.2013, this offer of Appointment stands
forfeited and no correspondence, whatsoever, would be entertained in the
matter thereafter. The candidates are advised to bring the following original
certificates/proformae on 01.04.2013 to RBTC without fail.
a) Joining Report (in the enclosed proforma).
b) Original Certificate in respect of graduation / Post graduation
(including technical or professional qualification, if any) along with
two xerox copies thereof.
c) Original Certificate of Computer Qualification / Experience
alongwith 2 xerox copies.

Certificate

d) Original Certificate in respect of SSLC or its equivalent examination

along with two xerox copies, evidencing proof of date of birth.
e) Five copies of recent passport size photographs (three photos signed
across), with name and date of joining written in block letters on the
reverse of the said photographs.
f)

Character/Conduct certificate by a Gazetted Officer and Testimonials

from 2 persons (not
related to the candidate), out of which, one
must be from the Principal/Head of Department of the College/
University which the candidate last attended, and one from a
respectable citizen of the place of his/her permanent residence.

g) Attestation Forms (2 sets) regarding the candidates antecedents duly

completed and signed (Forms enclosed).
h) Declarations of Marital status, Fidelity and Secrecy, Domicile as per
Schedules I to III and Schedule IV duly completed and signed(Forms
enclosed).
i) Bio data duly filled-in in the enclosed proforma (2 sets).
j) Personal Inventory (3 copies).
k) Original Caste Certificate in case of SC/ST and original certificates in
case of Physically challenged, Ex-Servicemen candidates as per the
proforma prescribed by government along with two xerox copies
thereof.

l) Original Caste Certificate in case of OBC candidates, in the proforma

enclosed, obtained on or after 01.04.2012.
m) Agreement on Non Judicial stamp paper of Rs.100/- duly attested by
Notary along with surety.
n) Certificate of Physical Fitness (Form enclosed).
o) Original discharge certificate from the previous employer or declaration
to the effect that he/she was not previously employed.
p) A Return containing full particulars of candidates Assets and Liabilities
(Form enclosed) as on the date of appointment in the Bank (ORA-52).
q) Statement showing particulars of loans availed along with a latest
certificate from the bank/Financial Institution. If no loans are availed, a
Declaration to that effect shall be submitted. (Form enclosed).
r) Residence certificate having resided for the last 5 years in the state of
Andhra Pradesh.
All the above formats are enclosed to the Appointment Letters sent to the
candidates which shall be duly filled in and to be submitted on reporting at
RBTC.
Further, please note that the appointment of the candidates is provisional
and is subject to the verification of the correctness of Date of Birth,
Educational Qualifications, Category (in case of SC/ST/OBC/Physically
Challenged/Ex-Servicemen), community certificate etc., being verified
through proper channels. If the verification reveals that the claim
regarding any of the above is false, the services of the respective
candidates will be terminated forthwith without assigning any further
reasons and without prejudice to such further action as may be taken under
the provisions of Indian Penal Code for production of false Certificates.
The candidates who do not receive the Appointment Letters by 27.03.2013
may contact the following numbers:
Land line-08562 222016; Mobile-94901 58009.

(V.KRISHNAMACHARY)
GENERAL MANAGER

Type on
Rs.100/Non Judicial
Stamp paper
THIS
AGREEMENT
is
made
and
executed
by
Sri/
Smt
/Kumari
__________________________________________________________ S/o, W/o, D/o of
_____________________________________ aged about _____ years, residing at
________________________ (hereinafter called the Probationary Officer) of the first
part and Sri/Smt/Kumari._________________________________________ S/o, W/o,
D/o of _____________________________________ aged about _____ years, residing at
___________________________ (hereinafter called the Guarantor) of the second part
in favour of ANDHRA PRAGATHI GRAMEENA BANK, a Bank constituted and functioning
under Regional Rural Banks Act, 1976 with its Head Office situated at Kadapa in Kadapa
District of Andhra Pradesh State, hereafter called the Bank.
WHEREAS the Probationary Officer has been selected by the Bank as an Officer Scale-I
and WHEREAS as per the appointment letter No. __________________________ dated
___________ , issued by the Bank to the Officer, one of the conditions of the
appointment is that the Officer should execute an agreement along with a Guarantor in
favour of the Bank agreeing to serve the Bank for a minimum period of 2 years from the
date of joining the services of the Bank and for such extended period as may be deemed
necessary and that in the event of his leaving the organization voluntarily / resigning
from the services of the Bank within a period of 2 years on his own accord, the
Probationary Officer and the Guarantor are jointly and severally liable to pay
compensation to the Bank; and
WHEREAS the Officer has agreed to join the Bank on __________ as a Probationary
Officer and in terms of the letter of appointment, the Officer along with a Guarantor
executes this agreement, the terms and conditions of which are as follows:
1. The Probationary Officer hereby agrees to serve the Bank for a minimum period
of TWO years from the date of joining, under the rules and Service conditions of
the Bank, irrespective of the place of posting or subsequent places of the
transfers, which are under the sole discretion of the Bank. The period of two
years active service in the Bank is taken in to consideration for the purpose.
If he/she wishes to leave the Bank voluntarily / resigns from the services of the
Bank or fails to extend two years of active service in the bank for any reason, the
Officer and the Guarantor hereby jointly and severally agree to pay Rs.1,50,000/(Rupees One lakh fifty thousand only) to the Bank by way of compensation
and/or liquidated damages on demand by the Bank.
2. The Officer shall be on probation for a period of Two Years in terms of Banks
service conditions and the above period of two years is extendable by one year
mentioned supra shall commence from the date of commencement of probation
period.

GUARANTOR

PROBATIONARY OFFICER

3. The Probationary Officer shall not, without the express prior approval in writing
of the appropriate authority in the Bank, apply for any job, accept assignment or
other employment for profit, until the Officer has fulfilled his/her obligation at
clause No.1 above. In case the Officer violates this and/or resigns to accept any
other fresh job, the amount mentioned above shall be paid before getting
relieved from the services of the Bank.
4. The Probationary Officer hereby agrees to obey and abide by all the rules,
regulations, service conditions, conduct & discipline of the Bank as per the
Andhra Pragathi Grameena Bank (Officers and Employees) Service Regulations
2010.
5. The Bank is at liberty to remove the Probationary Officer from the services of the
Bank during the period of probation without assigning any reasons or without
giving any prior notice by invoking regulation No.9 (2) (a) & 10 of Andhra
Pragathi Grameena Bank (Officers and Employees) Service Regulations 2010.
6. The Probationary Officer and the Guarantor shall be personally liable to pay the
above amount to the Bank not withstanding and without prejudice to the Banks
right to recover the said amount. In case of the Officers failure to make the said
payment, the Bank reserves the right to recover the same by appropriating any
sum that may be due to the Probationary Officer by way of salary, allowance,
Provident Fund etc., or any other terminal benefits due to the Officer and also
without prejudice to the Banks right to take any disciplinary action against the
Probationary Officer under the Service Regulations.
7. This agreement will remain in full force till the completion of two years of active
service, or the Probationary Officer and the Guarantor are discharged of all the
liabilities under this agreement by the Bank.
8. The Probationary Officer and Guarantor hereby agree faithfully to fulfill the terms
of this agreement and the Bank has agreed to take him/her as a Probationary
Officer on such assurances and on those promises.
9. Any dispute arising out of this agreement is subject to the jurisdiction of court in
Kadapa town only.
IN WITNESS WHEREOF we have set our hands unto this _______ day of
________________ 2012 at _______________________.

GUARANTOR
(Name:
Address:

PROBATIONARY OFFICER
(Name:

Witnesses:
01. Name
Address :

Signature:

02. Name
Address :

Signature:

SCHEDULE I
[See regulation 5(4) (ii)]
DECLARATION OF MARITAL STATUS
I, Shri/Smt/Kum _ __ ___ _ ___ ____ _ _ ________________________
S/o/W/o/D/o __ _____ ___ ___ ___ ___ __ ____ _____ ____ ____ declare as
under:
(i)

That I am unmarried/a widower/widow

(ii)

That I am married and have only one spouse living

(iii)

That I have entered into or contracted a marriage with a person

having a spouse living. I may be granted exemption based on ground
given below. Application for grant of exemption is enclosed.

Ground:

I solemnly affirm that the above declaration is true and I understand that in the
event of the declaration being found to be incorrect after my appointment, I shall
be liable to be dismissed from service.

Date:

Signature

SCHEDULE - II
(See regulation 19)
DECLARATION OF FIDELITY AND SECRECY

I, _____________________________, do hereby declare that I will faithfully,

truly and to the best of my skill and ability execute and perform the duties
required
of
me
as
officer
or
employee
of
the
ANDHRA PRAGATHI GRAMEENA BANK and which properly relate the office
or position held by me in the said Bank.
I further declare that I will not divulge or allow to be divulged to any person not
legally entitled thereto any information relating to the affairs of the said Bank or
to the affairs of any person having any dealing with the said Bank and nor will I
allow any such person to inspect or have access to any books or documents or
electronic records belonging to or in possession of the said Bank and relating to
the business of the said Bank or the business of any person having any dealing
with the said Bank.

Signature:
Name in full:
Designation:
Signed before me

Signature:
Name in full:
Designation:
Place:
Date :

SCHEDULE III
(See regulation 73)
DECLARATION OF DOMICILE

Place:
Date:
I, the undersigned having been appointed in the service of the ANDHRA
PRAGATHI GRAMEENA BANK hereby declare .....................................
(Place) in............................. (District) as my place of domicile.

The above is my place of birth.

or
The above is not my place of birth. My place of birth
is.................................(Place) in.....................................(District) but
...................................(Place) has been declared as my place of domicile
for the reasons given below.
.....................................
.....................................

Signature
Name in full
Designation and
Nature of appointment
Date of appointment

Strike out whichever is not applicable.

SCHEDULE - IV

Place:

Date:

I hereby declare that I have read and understood the Andhra Pragathi Grameena
Bank (Officers & Employees) Service Regulations 2010 and I hereby subscribe
and agree to be bound by the said regulations:

Name in full

Nature of appointment

Date of appointment

Signature

Witness

Date

ANDHRA PRAGATHI GRAMEENA BANK

HEAD OFFICE :: KADAPA
CERTIFICATE OF PHYSICAL FITNESS
Note: It must be signed by a Medical Officer not below the rank of an Assistant Civil
Surgeon employed under the Andhra Pradesh Government or by an Honorary Assistant
Civil Surgeon and Physician appointed by the Andhra Pradesh Government to a
Government Medical Institution.
A candidate who resides outside the Andhra Pradesh State and who is unable to produce
the certificate from a Medial Officer employed in the Andhra Pradesh State may produce
it from a Medical Officer of corresponding rank outside the Andhra Pradesh State.
The Certificate so produced will be subject to acceptance after further scrutiny.
Name and rank of the Officer granting the certificate:
I do hereby certify that I have examined (Full
Name).............................................................a candidate for employment in the service of
Andhra Pragathi Grameena Bank as ....................................................... and cannot
discover that he/she has any disease, constitutional affection or bodily infirmity except
that his/her weight is in excess of/below the standard prescribed or
except............................................................. I do /do not consider this a disqualification
for the employment he/she seeks. I also certify that he/she has marks of small pox
vaccination.
Chest measurement in inches: On full inspiration:
On full expiration:
Difference:
Expansion:
Height: ft.
Inches.
Weight in Lb._______
His/her vision is normal
Hypermetropiec (
correction glasses)

) ( here enter the degree of defect and strength of

Myopic (
strength of correction glasses)

) (Here enter the degree of defect and the

Asting (
of correction glasses).

) (here enter the degree of defect and the strength

Hearing is normal, defective (Much or slight):

Urine: Does chemical examination show (i) albumi
State specific gravity.

(ii) Sugar

Personal Identification Marks (At least two should be mentioned)

1)
2)
Signature:
Name :
Seal with Designation of Medical Officer

-2The candidate must make the statement required below prior to his/her medical
examination and must sign the declaration appended thereto. His/her statement is
specially directed to the warning contained in the note below:
1. State your name in full

2. State your age and birth place

3 a) Have you ever had small pox, intermittent or

any other fever, enlargement of suppuration
of glands, spitting of blood, Asthama,
inflammation of lungs, heart disease, fainting
attacks, rheumatism, appendicitis?
Or
a) Any other disease or accident requiring
Confinement to bed and medical or
Surgical treatment?
Or
b) Suffered from any illness, would or
Injuries sustained while on active service
During the war.
4. When were you last vaccinated?
5. Have you or any of your near relations been
afflicted with scrofula, gout, asthama, fits,
epilepsy or insanity?
6. Have you suffered from any form of
nervousness due to over work or any other
cause?
7. Furnish the following particulars concerning your family.
Fathers age if living
and state of health

Fathers age at death

and cause of death

Number of brothers
living, their ages and
state of health

Number of brothers
dead, their ages at
and causes of death

Mothers age if
living and state of
health

Mothers age at
death and cause of
death

Number of sisters
living, their ages and
state of health

Number of sisters
dead, their ages at
and causes of death

I declare all the above answers to be, to the best of my belief, true and correct.
Candidates Signature
Note: The candidate will be held responsible for the accuracy of the above statement by
willfully suppressing any information he/she will incur the risk of losing the appointment
and, if appointed, of forfeiting all claims to superannuation allowance or gratuity.

BIO DATA

Employee No.

Cadre

Identification Marks

: 1.
2.

I. Full name of the Officer/Employee

(in block letters)
Permanent address

:
:

Fathers name & Occupation

Husbands /wifes name and occupation

(if employed, give the particulars of his/her
designation, present place of working and
the address of the employer)

:
:
:
:

Date of joining in the Bank

Phone No

Age as on joining of the Bank

: __________________________ years.
Date of birth:_____________________
In words:

Place of Domicile

Native Place

:___________ ________ ________

Village

Religion

Caste

Whether belongs to SC/ST

Mobile No:

Taluk

District

Whether Physically Challenged/ ex- serviceman:

II. QUALIFICATIONS:
Educational qualifications

Technical qualifications

Languages known:

Can Read _________________________________

Can write__________________________________
Can speak _________________________________

Previous experience before joining the Bank

-2III. Marital Status

VI. Particulars of wholly dependents:

S.
No.

Name

Age

Relation

Immovable
Assets in the
name of
dependent, if
any*

Independent Annual
Income of the
Dependent, if any.

*Give details of immovable assets held in the name of the dependent, if any.
V. Assets that are standing in my name.
S.No.

VI. Special aptitude

Particulars of Immovable Assets

Value

I certify that the particulars given above are true and correct.

Place:
Date:

Signature of the Officer/Employee

CHARACTER & CONDUCT CERTIFICATE

This is to certify that Mr./Mrs./Ms. ,

S/o/W/o/D/o...,
is resident of . village/town. He/she is known to me since years.
His/her character and conduct are ..

PLACE:

Signature:

DATE:

Name:

Designation/Seal and address of Gazetted Officer

ANDHRA PRAGATHI GRAMEENA BANK : HEAD OFFICE : KADAPA

PERSONNEL DEPARTMENT
Personal Inventory
Affix latest
passport
EMPLOYEE NUMBER :

size colour photo

CADRE / DESIGNATION:
Date of joining in the Bank:.
Present place of working:.
I. 1. Full Name of the Officer/Employee: ..
2. Fathers /Husbands Name..

Fathers/Husbands Occupation. ....

3. Permanent address:..
...
Mobile No:. Phone No:
4. a) Date of Birth:
b) Age as on joining in the Bank: Years . Months days

5. Place of Domicile (place of Birth):..

6. Native Place: Village . MandalDistrict

Place of own house
constructed: Village/TownMandalDistrict...
7. Religion ::.
8. Caste (furnish name of the caste ..
and also sub-sect, if any)
: ...
(P.T.O.)

-29. Whether belongs to SC/ST/BC (A/B/C/D):.

(Specify the Group and its Number) (Eg. BC-B-6)
10. Whether belongs to PH/Ex.service: .
11. Identification marks

: 1).

(as per SSC/SSLC Certificate)

: 2).

II. 1. Educational qualifications & Professional

qualifications (Furnish attested certificates of

additional qualification, if any, acquired

recently and not recorded in / reported

4...

to Bank.)

2. Technical qualifications & Computer skills :

.
3. Languages Known : Can Speak 1.23..4.
Can Write 1.23..4
Can Read 1.23..4
4. Previous experience (before joining in the Bank..........................................

III. 1. Marital Status: (Married /Unmarried/Widow/Widower)

2. Date of Marriage : 1st2nd..
(in case of

2nd marriage . Furnish reasons (i) Divorce

(ii) Spouse deceased

iii. )
3. Number of Children:..

(P.T.O.)

-3IV. PARTICULARS OF WHOLLY DEPENDENTS ON THE EMPLOYEE /OFFICER.

Name
Sl
RelationDate of
Annual
Details of immovable
Age
No.
ship
Birth
income assets (land/site/house
etc.), if any, in the name
Rs.
of dependent
1
2
3
4
I confirm that the annual income particulars shown above are true and correct. The persons mentioned
above are wholly dependent on me.
Note: If the monthly income of a family member/dependent exceeds Rs.3500/- he shall not be treated as
wholly dependent of the staff member.
V. EMPLOYMENT PARTICULARS OF SPOUSE.
Name of the
Organisation

Place of work

Position held

Date of
joining in
the service

Total emoluments
per month
(Rs.)

VI. PARTICULARS OF EPF NOMINEE : ( FOR EPF /PENSION PURPOSE).

S.No.

Name

VII. Income Tax Pan No.

VIII. Declaration

Age.

Relationship

Address.

I hereby declare and confirm that all the particulars furnished above are true and correct to the best of
my knowledge and belief.
Date:
Place:
Signature of the Staff Member
The information furnished by the staff member is forwarded to Head Office.
Branch:
Date::

MANAGER
(Name)
Employee No. ..

TESTIMONIAL
This is to inform that Mr/Mrs/Ms S/o / W/o /

D/o

. residing at
.
......... is known to me for the last . Years and he/she is hard working and sincere. His/her
character and conduct are ...

Place:
Date:

Signature:
Name:
Address:

------------------------------------------------- cut here-----------------------------------------------------------------------------TESTIMONIAL

This is to inform that Mr/Mrs/Ms S/o / W/o /

D/o

. residing at
.
......... is known to me for the last . Years and he/she is hard working and sincere. His/her
character and conduct are ...

Place:
Date:

Signature:
Name:
Address:

ANDHRA PRAGATHI GRAMEENA BANK

HEAD OFFICE :: KADAPA
ATTESTATION FORM

(To be filled in by the candidates own hand writing)

01. Name in full in Block Capital Letters
with aliases if any
.
(Please indicate if you have added or
Dropped at any stage any part of full
name and surname)

02. Present address in full (i.e.,)

Village, Mandal and District or House
No. Lane, Street & Road

....

Surname

Name

Affix passport
size (Colour
photo) duly
attested by
Gazetted
Officer

03. (a) House address in full (i.e.,)

Village, Mandal and District or House
No. Lane, Street & Road
..
(b) If Originally a resident of Pakistan
The Address in that Dominion &
The data of immigration to Indian Union

..

04. Particulars of places where you have resided for more than one year during the preceding five years:
Residential address in full (ie.,
From
To
Village, Mandal and District or
House No. Lane, Street and Road)

05. Fathers

(a) Name in full with aliases

If any

..

(b) Present Postal address

(if need give last address)

..

(c ) Permanent home address

..

(d) Profession

..

(e) If, in service give designation

and official address
..
06. Nationality of:
Place of birth of

(a) Father
(b) Mother
(c ) Husband / wife
(a) Husband
(b) Wife

P.T.O

-207.

(a) Date of birth (DD/MM/YY)

(b) Present age
(c ) Age at matriculation

..
..
..

08.

(a) Place of birth, District and State

(b) District and State to which you belong

..

(a) State your religion

..

(b) Are you a member of Scheduled

Caste/Scheduled Tribe /OBC
State Yes or No and if yes
State the name there of

..

09.

Education qualifications showing place of education with years in school and college since 15th
year of age
Name of school/college
Date of entering
Date of leaving
Examination passed
with full address

10.

11.

If you have at any time, been employed give details.

Designation of post/s held and
description of works

Period
From

to

Full address of the office/ firm or

institution

P.T.O

-3 12. Have you ever been convicted by a

Court of Law for any offence
(If the answer is yes the full particulars
of convictions and the sentence should be
given)
13. Name of the two responsible persons
Of your locality or two references to whom
You are known
(Furnish with full addresses)

..
(1)

(2)

I Confirm that the above particulars and foregoing information are 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/ Public Sector enterprises/Banks etc.
Date :
Signature of Candidate
Place :
CERTIFICATE TO BE SIGNED BY ANY GAZETTED OFFICER (CENTRAL/STATE), MPDO, MRO,
PRINCIPAL OF COLLEGE, HEAD MASTER OR MEMBER OF LEGISLATURE, MEMBER OF LEGISLATIVE
COUNCIL, MEMBER OF PARLIAMENT ETC.
Certified that I know
Sri / Smt / Kumari __________________________________________________________________
D/o W/o. son of Sri _________________________________________________________________
for the last ___________________________________Years ________________________________
months & that the particulars furnished by him are correct to the best of my knowledge and belief.
Place :

Signature
Designation

Date :

Office Seal

Status and Address

Declaration to be signed by the Candidate

01. I hereby declare that the statements made in this form are true to the best of my knowledge &
belief.
02. I am unmarried /married & have only one spouse (delete which ever is not applicable)

03. I am fully aware that furnishing of false information or suppression of any actual information in
the attestation form should be a disqualification and be liable to render me unfit for employment
under the Government/Public Sector enterprises/Banks etc.
04. I am also fully aware that if it comes to notice at any time during my service that false
information has been furnished or that there has been suppression of actual information in the
attestation form, my service should be liable to be terminated on this ground.

Date:

Place:

Signature of the Candidate

JOINING REPORT
Date :
From:
.
.

.
To
The Chairman
Andhra Pragathi Grameena Bank
Head Office
K A D A P A.
Through the Director, Rural Banking Training Centre, Anantapur.
Dear Sir,
Sub: Appointment as Officer Scale I (Assistant Manager)/ Officer Scale II (Manager)/ Officer Scale III
(Senior Manager) on Probation in your Bank-Reg.
Ref: Andhra Pragathi Grameena Bank, Head Office, Kadapa, Appointment Order No.
., dated .. .

In terms of the above appointment order, I am reporting for duty today i.e., on . at
.A.M.
Please accept my joining report.
Yours faithfully,

Forwarded

DIRECTOR-RBTC
Copy to The Regional Manager, Regional office ____________________Region.

OBC CASTE CERTIFICATE FORMAT

APPENDIX I
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR
APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that Son/daughter of
village..District/Division ...in
.State..belongs to ...........................community
which is recognized as a backward class under.
1. Resolution No. 12011/68//93-BCC dated 10.09.1993 published in the Gazette of India, Extra
ordinary, Part-I, Section I, No. 186 dated 13.09.1993.
2. Resolution No. 12011/9/94-BCC dated 10.10.1994 published in the Gazette of India, Extra ordinary,
Part-I, Section I, No. 163 dated 20.10.1994.
3. Resolution No. 12011/7/95-BCC dated 24.05.1995 published in the Gazette of India, Extra ordinary,
Part-I, Section I, No. 88 dated 25.05.1995.
4. Resolution No. 12011/44/96-BCC dated 06.12.1996 published in the Gxazette of India, Extra ordinary,
Part-I, Section I, No. 210 dated 11.12.1996.
5. Resolution No. 12011/68/93-BCC published in the Gazette of India, Extra ordinary No. 129,
dated 08.07.1997.
6. Resolution No. 12011/12/96-BCC published in the Gazette of India, Extra ordinary No. 164,
dated 01.09.1997.
7. Resolution No. 12011/99/94-BCC published in the Gazette of India, Extra ordinary No. 236,
dated 11.12.1997.
8. Resolution No. 12011/13/97-BCC published in the Gazette of India, Extra ordinary No. 239,
dated 03.12.1997.
9. Resolution No. 12011/12/96-BCC published in the Gazette of India, Extra ordinary No. 166,
dated 03.08.1998.
10. Resolution No. 12011/68/93-BCC published in the Gazette of India, Extra ordinary No. 171,
dated 06.08.1998.
11. Resolution No. 12011/68/93-BCC published in the Gazette of India, Extra ordinary No. 241,
dated 27.10.1999.
12. Resolution No. 12011/88/98-BCC published in the Gazette of India, Extra ordinary No. 270,
dated 06.12.1999
13. Resolution No. 12011/36/93-BCC published in the Gazette of India, Extra ordinary No. 71,
dated 04.04.2000.
Shri..And/or
his
family
ordinarily
resides
in
the
..District/Division of the ..State. This is also to certify that he/she does not
belong to the persons/sections (Creamy Layer) mentioned in column 3 of the Schedule to the
Government of India, Department of Personnel & training OM No. 36012/22/93-Estt(SCT) dated
08.09.1993. Dated : Tahsildar District Magistrate/Dy. Commissioner etc.
NB.
a) The term ordinarily used here wil have the same meaning as in section 20 of the Representation of
People Act 1960.
b) The Authorities competent to issue Caste/Tribe/Community certificates are indicated below.
i) District Magistrate/Additional Magistrate/Collector/Deputy Commissioner/ Additional Deputy
Commissioner/Deputy Collector/Ist Class Stipendiary Magistrate/Sub Divisional Magistrate /Taluk
Magistrate/Executive Magistrate/Extra Assistant Commissioner (Not below the Rank of Ist class
Stipendiary Magistrate.

ii)
Chief
Presidency
Magistrate/Additional
Chief
Presidency
Magistrate/Presidency
Magistrate/Presidency Magistrate
iii) Revenue Officer not below the rank of Tahsildar and
iv) Sub-Divisional Officer of the area where the candidate and or his family resides.
--------

ORA-52-A
ANDHRA PRAGATHI GRAMEENA BANK
HEAD OFFICE: KADAPA
Branch/Office: __________________________
STATEMENT OF MOVABLE PROPERTY AS ON 01.04.2013
Name in full: _______________________________________

Date of last return: ______________________

Dept. / Office / Branch: _______________________________

Date of appointment: ____________________

Employee No.: ______________________________________

Present Basic Pay & Allowances: ___________

Present Post held: ___________________________________

Number of dependants: __________________

S.
No.

Description

Registered No. or
specific particulars

In whose name the

same is held

Date of
acquisition

How acquired whether

by purchase or lease

1.

Ornaments & Jewellery

2.

Vehicles

3.

All types of utensils

4.
5.
6.

Shares, stocks, debentures or

any other type of securities
Cash (including all kinds of
deposits)
Others

ORA-52-A

S.
No.

Page No.2

Description

Ornaments & Jewellery

Vehicles

All types of utensils

Shares, stocks, debentures or

any other type of securities
Cash (including all kinds of
deposits)
Others

5
6

Value of the
property at the
time of
acquisition

Present market
value

Sources of funds

If acquired by private
borrowings, the date and
details of such borrowings
whether repaid and how

I hereby declare that the above statement is complete, true and correct to the best of my knowledge and belief.

Date:

Signature of the officer

ORA-52-B
ANDHRA PRAGATHI GRAMEENA BANK
HEAD OFFICE::KADAPA
Branch: __________________________
STATEMENT OF IMMOVABLE PROPERTY AS ON 01.04.2013
Name in full: _______________________________________

Date of last return: ______________________

Dept. / Office / Branch: _______________________________

Date of appointment: ____________________

Employee No.: ______________________________________

Present Basic Pay & Allowances: ___________

Present Post held: ___________________________________

Number of dependants: __________________

Details of acquisition

S.
No.

Name of District, Division

Mandal and Village in
which property is
situated

Details of the property

Housing and other Buildings

Land

Date
acquired

Value at the
time of
acquisition
6

If not in his own name

state in whose name
held and his / her
relationship with the
Officer
7

ORA-52-B

S.
No.

How acquired whether by

purchase, lease mortgage,
inheritance, gift or otherwise
with date of acquisition and
name with details of persons
from whom acquired
8

Page 2

Cost of investments,
repairs, renovations
etc. if any made
during the period
under report

Remarks as to sources of funds

if acquired by invested from out
of private borrowings, date and
details of such borrowings
whether repaid and how

Annual income
from the property

Approximate
present market
value

10

11

12

I hereby declare that the above statement is complete, true and correct to the best of my knowledge and belief.

Date:

Signature of the Officer

ORA-52-C
ANDHRA PRAGATHI GRAMEENA BANK
HEAD OFFICE: KADAPA
Branch: __________________________
STATEMENT OF LIABILITIES AS ON 01.04.2013
Name in full: _______________________________________

Date of last return: ______________________

Dept. / Office / Branch: _______________________________

Date of appointment: ____________________

Employee No.: ______________________________________

Present Basic Pay & Allowances: ___________

Present Post held: ___________________________________

Number of dependants: __________________

Sl.
No.

Amount

Name and address of

Creditor

Date of
incurring
liability

Details of
transaction

Purpose for which

the debt/liability
was incurred

HO permission
Ref.No., if the debt is
from outsiders

Remarks

01
02
03
04
TOTAL
I hereby declare that the above statement is complete, true and correct to the best of my knowledge and belief.

Date:

Signature of the Officer

ORA-52-D
ANDHRA PRAGATHI GRAMEENA BANK
HEAD OFFICE: KADAPA
Branch: __________________________
STATEMENT OF SALES/PURCHASES DURING REVIEW PERIOD AS ON 01.04.2013
Name in full: _______________________________________

Date of last return: ______________________

Dept. / Office / Branch: _______________________________

Date of appointment: ____________________

Employee No.: ______________________________________

Present Basic Pay & Allowances: ___________

Present Post held: ___________________________________

Number of dependants: __________________

Sl.
No.

Description

Registered number
or specific
particulars

Date of sale/ purchase

Date

Amount Rs.

Details of
transaction

Source of funds/
Use of funds

HO permission
Ref.No.

01
02
03
04
05
I hereby declare that the above statement is complete, true and correct to the best of my knowledge and belief.

Date:

Signature of the Officer