1/3

ON-LINE APPLICATION FOR SINGLE WINDOW OPERATOR(SWO)

16027

Registration #: 3011632

Full Name: MALLIKARJUNA GUNDEMADUGULA

Category : SC

If Person with Disability : NO

Type of Disability : -- Percentage of Disability : --
Do you intend to use the services of a scribe?( only for VH and OH
NO
candidates whose writing speed is affected by cerebral palsy)? :

Are you candidate who had ordinarily been domiciled in Kashmir

NO
Division of the State of J&K during the period 1-1-1980 to 31-12-1989?
Whether you belong to Religious Minority Community? : NO
Religion to which you belong : --
Are you an Ex-Serviceman? : NO

Are you a disabled Ex-Serviceman (DISXS)? : NO

Period of Service in months : --
Are you a dependent of an Ex-Serviceman (DXS)? : NO
Are you seeking relaxation under widow/divorced women/
women judicially Separated from their husbands and who are NO
not re-married :
Nationality : INDIAN
State / Union Territory for which you are applying : Andhra Pradesh
State code : 02
Centre of Examination : Vijaywada

Centre code : 32

Application Fee / Postal Charges Details :

Receipt Number (TSL No.) : RF000255

Branch Name : NIZAMABAD

Branch Code No : 183

Date of Deposit : 06-04-2011

Amount : 50

Personal Details :
Date of Birth : 20-03-1984

Age as on 31.03.2011: 27
Gender : MALE

Father's Name / Husband's Name : KONDAIAH

Mother's Name : KONDAMMA

Address for Correspondence : RGUIIIT
 2/3
BASAR
MUDHOLE

District ADILABAD
State : ANDHRA PRADESH

Pin : 504107
Permanent Address : CHINNAPAVANI

LINGSAMUDRAM

KANDUKUR
District PRAKASAM

State : ANDHRA PRADESH

Pin : 523115

Contact Details:
Phone No : 08752-243344
Mobile No: 9676322721

Email ID : malli112009@gmail.com

Qualification Details (as on 31.03.2011):

Exams Passed Subject/Stream Year of Passing % of Marks Class / Grade

Graduation : BSC 2006 58.50 Second Class

Others : PGDIT 2008 83.00 First Class

working knowledge of computers : YES

Details of Computer Knowledge : MS Office

Other Details :

Whether desirous of taking Pre-Exam Training (SC/ST/Ex-

NO
Servicemen/Minority Community/DISXS/DXS) :

If Yes Centre for Training : --

Languages Known Read Write Speak

ENGLISH YES YES YES

HINDI YES YES YES

TELUGU YES YES YES

DECLARATION:
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 Mangalore and courts/ Tribunal/ forums at Mangalore 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:
Date: 08-04-2011 Signature of Applicant

Please retain your Registration No. and Password emailed to you carefully for further reference
 3/3
NOTE: Please DO NOT SEND application print-out to the Bank