Andhra Bank Recruitment Project-2002 C/o Institute of Banking Personnel Selection, Post Bag No.

8591, Kandivali (East), Mumbai 400101 With reference to your advertisement No. I submit my application in the prescribed format. Dated

1. Name (Mr./Mrs./Ms.). (in BLOCK LETTERS) 2. Maiden Name (in case of Married Women). 3. a) Correspondence Address . . ..Pin . b) Permanent Address . . ..Pin . (For ease in Computer Processing, Name and Address should be filled using CAPITAL LETTERS IN ENGLISH only) 4. Choice of Centre for Written Examination.Centre Code No 5. Post Applied For ..Post Code No.. 6. Additional post(s) applied for ..Post Code No.. 7. Indicate Category to which you belong by marking X in the appropriate box. SC ST OBC GEN (Strike out whichever is not applicable) 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 Jammu and Kashmir Yes No during the period of 01.01.1980 to 31.12.1989? c) Are you suffering from any orthopedic disorder(s)? Yes No If you are an OH candidate please mention percentage of disability d) Are you visually impaired? Yes No 8. a) Date of Birth (As per School Leaving Certificate/SSC) . b) Age as on 01.01.2002 . 9. Particulars of Demand Draft/Bank Pay Order Name & Address Name & Address Date of Issue Demand Amount of the Issuing of the Drawee Draft/Bank Pay Bank Bank Branch Order No. (Fees for the post: Rs.135/- [including postal charge] for General Candidate [including OBCs] and Rs.35/- [postal charge] for SC/ST/OH/VH candidates)

10. In case of SC/ST/OBC candidate i) Name of the Caste ii) Name of the State to which you belong 11. Nationality

12. Place of Birth: TownDistrict..State.. 13. Sex: Male Female 14. Fathers / Husbands Name. 15. Age relaxation claimed, if any: (Specify basis and enclose relevant certificates) YES NO

16. In case of Ex-Serviceman/Commissioned Officer/Police Officer/other equivalents, specify i) Date of Discharge . ii) Rank at Present/last held a) Acting w.e.f b) Substitute w.e.f 17. a) Educational and Professional Qualifications (as on the date of application, Matriculation /SSLC onwards to be supported by attested copies of the certificate. Do not enclose originals): Examination Passed Name of the Institution/ University Subjects studied Date-Month-Year of Passing Percentage of Agg. Marks

b) Computer Education Examination Passed Name of the Institution/ University Subjects studied Date-Month-Year of Passing

c) Details of any other requirement ..

18. Particulars of Post-Qualification Experience including the present occupation/job (as on the date of application) Name of employer(s)/firm, etc. and the nature and details of activities carried out by the employers Designation and rank if any Period of service Length of Service Years / Month / Days Nature of Remarks Duties (Reasons performed in for detail leaving services)

(Strike out whichever is not applicable) 19. a) I belong to SC/ST/OBC/Oh/VH category and I am enclosing an attested photocopy of the prescribed certificate Yes No 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 found 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 hereby agree that any legal proceedings in respect of any matter(s) or claim(s) or dispute(s) arising out of this application and/or out of said advertisement can be instituted by me only at Hyderabad and the Courts/Tribunal/Forums at Hyderabad 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 Nodatedof the Bank.

PLACE: DATE:

SIGNATURE OF THE CANDIDATE