APPLICATION FORMAT

(Fill up all columns in legible capital letters and mark
in appropriate box/es)
(SEALED ENVELOPES SUPERSCRIBED “PSB CLERICAL RECRUITMENT PROJECT – 2010-11”
BE ADDRESSED TO AS UNDER).
Please affix your
recent coloured
To passport size
photograph and
Post Box No. sign across.
Please retain
___________ five copies of the
___________ same for
subsequent use.
With reference to your advertisement No.____________ in Employment News/ Rozgar Samachar dated
____________ I submit my application in the prescribed format.

1. FULL NAME IN BLOCK LETTERS: (Leave one space blank between two parts of your names)
Mr./Ms.

2. ADDRESS FOR CORRESPONDENCE (IN BLOCK LETTERS)

PIN CODE

Contact No./ Phone No. ( with STD code)

Mobile No. Email ID

3. CENTRE OF EXAMINATION _________________________ CODE :

(IN BLOCK LETTERS)

4. POST APPLIED FOR: State/UT___________________ CODE :

5. CATEGORY TO WHICH BELONG: SC ST OBC GEN

Indicate by ‘
’ mark in appropriate box. (Please enclose photocopy of certificate.)

6. If Physically challenged , please indicate

OC HI VI DXS DISXS
( Please enclose certificate issued by Medical Board at District level specifying type of handicap and
percentage of disability).
7. (a). DATE OF BIRTH ( As per school leaving certificate SSLC/SSC)

DD MM YY

(b). AGE (As on 01.01.2010):______ Years_______Months________Days.

Relaxation in age (if claimed) : No. of Years ____ Under category__________

8. DETAILS OFAPPLICATION FEE:

Name and Name and address of Date of Issue DD/Bank Amount

address of the the drawee Bank pay order (Rs.)
issuing Bank No.

[Fee for the post is Rs. 300/- - for General/OBC Candidates (including Postage) and Rs. 50/- (postage only)
for SC/ST/Persons with Disability (PC) candidates/ Ex-Servicemen/DISXS/DXS]. Payment by Cash,
Cheque, Postal Stamps, Money Order, etc. will not be accepted and such applications will be rejected.

Note :

i.) Requisite Application Fee/Postage Charges be sent by Demand Draft / Pay Order favouring “Punjab
& Sind Bank A/c Clerical Recruitment Project – 2010-11” payable at “Mumbai” only along
with application. Candidate’s Name, Address and Name of the Centre should be written on
the reverse of the Demand Draft/Pay Order.
ii.) Candidate must write his/ her name, date of birth & address on the reverse side of the Bank Draft/
Banker’s Cheque.
iii.) Payment of postage charges/Application Fee by Cash / Cheques / Money Orders etc. will not be
accepted.
iv.) Bank Draft or Banker’s cheque / postal order, must be purchased on or after the date of
advertisement but on or before the last date of receipt of application.
v.) Payment by any other mode will not be accepted.
vi.) Application once made will not be allowed to be withdrawn and fees once paid will not be refunded
on any account nor can it be held in reserve for any other selection process.
vii.) Applications should be accompanied with copies of relevant certificates/testimonials duly attested by a
Gazetted Officer.

9. To be filled in only by those SC/ST/Minority Community/Ex. Serviceman candidates, who are desirous of taking Pre
Exam. Training.

(i) WOULD YOU LIKE TO UNDERGO PRE-EXAM TRAINING: YES NO

indicate by ‘
’ mark in appropriate box.
(ii) IF YES , CHOICE OF CENTRE FOR PRE-EXAM TRAINING: _____________

10. INDICATE BY ‘
’ MARK IN APPROPRIATE BOX :

(i) GENDER: MALE FEMALE

(ii) a) Are you Ex-serviceman ? : YES NO

b) In case of Ex-serviceman/Commissioned Officer/Police Officer/

Other equivalents. Specify
1. Date of Discharge : ____________________________________
2. Rank at present /last held A) Acting _________w.e.f._________
B) Substantive __________w.e.f._____

(iii) Are you a candidate who is ordinarily being domiciled in Kashmir Division
YES NO
of State of Jammu & Kashmir during the period 01.01.1980 to 31.12.1989.

If yes, enclose a copy of certificate issued by the Competent Authority.

(iv) Whether you belong to Minority Community? YES NO

If yes, please state the religion: ________________________________

 (v) In case of SC/ST/OBC Candidate
(i) Name of the Caste/Tribe/Class :____________________________
(ii) Name of the State to which you belong : _____________________

(vi) Whether you are a widow / divorced woman ? YES NO

11) FATHER’S / HUSBAND’S NAME ( IN BLOCK LETTERS):

12) NATIONALITY: _____________________

13) PLACE OF BIRTH: Place__________Dist___________State ___________

14) PERMANENT ADDRESS:

PIN CODE

15) EDUCATIONAL AND PROFESSIONAL QUALIFICATION

(From 10th Standard Onwards, as on 01.01.2010). (please enclose Xerox copies of mark sheet and certificates):

Examination passed Name of the Board/ Subjects studied Month & Year of %age of
Institution/University in detail Passing Marks

16) PARTICULARS OF POST-QUALIFICATION EXPERIENCE

(As on 01.01.2010).

Name of Employer & Designation Period of service Length of service Nature of Remarks
Nature of activities duties performed (Reason for
carried out by them From To Years Month leaving service)
17. Languages known :

(Read) (Write) (Speak)

________ ________ _________

________ ________ _________

________ ________ _________

18. ANY OTHER INFORMATION:-

BEFORE MAILING APPLICATION PLEASE CHECK THAT YOU HAVE CORRECTLY MENTIONED.

i) The State applied for

ii) The Centre where you wish to appear at.
iii) Category / sub-category and have enclosed copies of necessary certificates for SC/ST/OBC/PH
Candidates.
iv) Details regarding fees (Demand Draft / Pay order).
v) Address for Correspondence.
vi) Details for claiming relaxation in age and have enclosed the relevant certificate.

DECLARATION

I hereby declare that all the 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 found false or incorrect at
any stage or not satisfying the eligibility criteria according to the requirements of the relative advertisement,
my candidature / appointment is liable to be cancelled / terminated. I have not been debarred from taking up
the test / selection by any bank/CRB/BSRBs/IBPS and I have not been convicted in any criminal case. I am
willing to serve any where in India, if selected. I agree that Bank has right to transfer me to any part of the
country at its discretion.

I hereby 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 at New Delhi and
Courts/Tribunals/ Forums at New Delhi only shall have sole and exclusive jurisdiction to try any
cause/dispute. I undertake to abide by all terms & conditions mentioned in the advertisement given by the
bank with regard to this recruitment.

PLACE: _______________ DATE: _______________ SIGNATURE OF APPLICANT