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ON-LINE APPLICATION FOR BANK OF BARODA CLERKS RECRUITMENT PROJECT

29040
Please paste your recent
passport size photograph
and sign across it. Please
retain atleast 5 copies of
same photograph with you
for subsequent use.

Registration # : 3291743
Full Name : Ms Mukhopadhyay Gargi
Category : GENERAL
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 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?
Are you Children/family members of those who died in 1984 riots NO
Whether you belong to Religious Minority Community NO
Minority Religion : --
Are you an Ex-Serviceman (Including ECO/SSCO)? NO
Are you a disabled Ex-Serviceman (DISXS) NO
Are you a dependent of an Ex-Serviceman (DXS) NO

Have you passed in Service (Departmental) Examination which is equivalent

NO
to Civil Examination not below the rank of HSC?
Are you seeking relaxation under widow/divorced women/women judicially/
NO
Separated from their husbands and who are not re-married?

District Preference for Posting :

District Preference 1 : Kolkata
District Preference 2 : Howrah
District Preference 3 : Hooghly

Are you an employee of Bank of Baroda : NO

If yes,E. C. No :

Nationality : Indian
State / Union Territory for which you are applying : West Bengal

State / UT code : 38
Centre of Examination : KOLKATA

Centre code : 47

Application Fee / Postal Charges Details :

Transaction ID : M345432

Branch Name : Lake Market

Branch Code No : Lakema0022

Deposit Date : 31-01-2011

Amount : 200

Personal Details :
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Date of Birth : September 19,1983 Age as on on 01.01.2011. : 27

Gender : FEMALE
Father's Name/ Husband's Name : Subhashis Mukhopadhyay

Mother's Name : --
Email ID : subhashism@rediffmail.com

Address for Correspondence : 114/1 Br B G T Road Lal Bari

P.O. Bhadrakali

District Hooghly
State : WEST BENGAL

Pin : 712232

Permanent Address : 114/1 Br B G T Road Lal Bari

P.O. Bhadrakali

District Hooghly
State : WEST BENGAL

Pin : 712232

Contact Details:
Phone No : -
Mobile No: 9830229263

Qualification Details (as on 01.01.2011):

Exams Passed Subject/Stream University / Board Year Of Passing % of Marks

HSC / Equivalent : Science WBBHSEWest Bengal 01-07-2002 68.10

Graduation : Economics Calcutta University 01-09-2005 50.00

Others : M Sc Economics Others 01-09-2007 45.00

Diploma in Banking : NO

Possess certificate in computer literacy : YES

Post qualification work experience details as on 01.01.2011 (Start from Present Employer) :

No Experience

Other Details :

Whether desirous of taking Pre-Exam Training

--
(SC/ST/PWD/Minority Community) :
If Yes Centre for Training : --

Languages Known Read Write Speak

English YES YES YES

Bengali YES YES YES

Hindi YES YES YES

DECLARATION:
I hereby certify that the information furnished above 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(s) or claims or disputes arising out of this application or out of said advertisement
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can be instituted by me only at Mumbai and Courts/Tribunal/ Forums at Mumbai 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: 01-02-2011 Signature of Applicant

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