भ रत य स ट ट ब क म व श षज ञ स र ग क अव क ररय क भत ऩद : च प म न जर (क स ट अक उ ट ट)

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1 भ रत य स ट ट ब क म व श षज ञ स र ग क अव क ररय क भत ऩद : च प म न जर (क स ट अक उ ट ट) RECRUITMENT OF SPECIALIST CADRE OFFICERS IN STATE BANK OF INDIA Post: Chief Manager (Cost Accountant) स त क र क ददन क : DATE OF INTERVIEW: क न द र / CENTRE: Corporate Centre, MUMBAI ऩ ज यन न./ REGISTRATION NO. : न म / NAME : वर ग/ CATEGORY : क य गऱय क उऩय र ह त FOR OFFICE USE ONLY 1) स त क य भ सम मभलरत ह न क ददन क : Date of appearing in interview : 2) म ग मत / प रभ णऩत र क सत म ऩन कयन व र अधधक य क न भ : श र /श र भतत/ क Eligibility/ Certificates verified by: Shri/Smt/ Kum. : 3) कलभम तथ प र प त ववस गततम : Deficiencies and Discrepancies found : प रभ णऩत र क सत म ऩन कयन व र अधधक य क ऩदन भ एव हस त य Signature & Designation of Documents Verifying Official ऩदन भ Designation AGM/CM हस त य Signature (1)

2 क न द र य भत एव ऩद न द नतत ववभ र CENTRAL RECRUITMENT & PROMOTION DEPARTMENT प रत य श क आत मकथ य एव सत य ऩन प मग CANDIDATE'S BIO-DATA-CUM-ATTESTATION FORM (क ऩय स वध न ऩ वगक ऩढ़न क ऩश च त अऩन हस तलऱवऩ म भर ) (Please fill in the form in your own handwriting after reading carefully) Paste a copy of passport size photograph which was pasted on call letter at the time of examination and sign across it in full with date मह ऩ सऩ र ट आक य क वह प र ध ऩक ए म स क प रतत आऩन ऩय क सभम क र र र य ऩय ध ऩक ई थ तथ उस ऩय ददन क सदहत ऩ णट हस त य कय स त क य क लरए क न द र : Centre for Interview: Corporate Centre, Mumbai. ददन क / Date : ऩदन म : च प म न जर (क स ट अक उ ट ट) यम स र शन क रभ क / Registration No. : Name of Post: Chief Manager (Cost Accountant) स त क य ह त ब ष क ववकल ऩ : दहन द द / अ ग र Choice of Language Interview: Hindi/ English 1. (क) ड ग र प रभ णऩत र क अन स य स स ऩष र अ य भ ऩ य न भ : Name in full, in block letters as per degree certificate: श र / श र भत / क Shri/Smt./Kum. : व व दहक म स थतत: ववव दहत / अववव दहत Marital Status : Married / Unmarried 2. (क) न द भ ततधथ Date of Birth ददन क /Date भह न /Month वषट /Year (ग) (c) 3. (क) 4. (क) 5. (क) 6. (क) दस त व ज़ उद हयण थट ह ईस क र प रभ णऩत र, ऩ सऩ र ट इत म द क अन स य (क ऩम स रग न कय ) As per High School Certificate, Passport, Others (please enclose) : न द भ क स थ न : म र : य ज म : Place of Birth : District : State : म र तथ य ज म ह क आऩ तनव स ह : District and State to which you belong : य ष र मत : Nationality : धभट : Religion : वऩत / ऩतत क न भ एव व मवस म / ऩदन भ : Father's /Husband's name and occupation/profession/designation: भ त क न भ एव व मवस म Mother's name and occupation : य ष र मत : वऩत : भ त : ऩतत/ ऩत न Nationality : Father : Mother : Husband/ Wife: ऩतत/ ऩत न क न द भ स थ न : म र : य ज म: Place of Birth of Husband/ Wife : District : State : श र ण वगट (मथ ध त आमत भ सह क ध न द ह रग ए) Category (Tick the appropriate box) अन स ध त तत/अन स ध त न तत/अन द म वऩछड़ वगट क उमभ दव य तत/ न तत/ सभ द म क न भ द SC / ST / OBC candidates state the name of CASTE / TRIBE / COMMUNITY (ग) मदद आऩ ववकर ग ह त क ऩम मथ ध त आमत भ सह क ध न द ह रग ए (c) स अम स थ ववकर ग म द म ष र ववकर ग If you are Physically Challenged, please tick appropriate box. i.e. OH or VH. अ अ अ वऩ व स भ न द म SC ST OBC GEN अम स थ ववक OH द म ष र ववक VH (2)

3 (घ) (d) 7. (क) 8. (क) मदद आऩ श य रयक र ऩ स ववकर ग ह त उसक वववयण द. If you are a Physically Challenged person, please give details of your handicap. मदद आऩ प रत म वततटत / प रव स / ववस थ वऩत व मम तत ह त उसक वववयण द. If you are a repatriate / migrant / displaced person, give particulars : मदद आऩ ब तऩ वट स तनक ह त क ऩम क मटभ म तत / स व तनव त क ततधथ क उल र ख कय. If Ex-serviceman, please give date of discharge / retirement. भ त ब ष : Mother Tongue : अ ग र क अततरयतत अन द म ब ष ओ क न Knowledge of languages other than English क र. ब ष फ र सकत ह ऩढ़ सकत ह लरख सकत ह उत त णट ऩय ए, मदद क ई ह त SN. Language Speak Read Write Examination passed, if any शश णणक म ग मत ओ क वववयण: क र अ क एव प र प त क क रभ भ सब ववषम स एम छछक, ऩ स क सट म ऑनसट क सट क अ क ड़ कय दश टम (स फद प रभ णऩत र तथ अ कऩत र क प रततलरऩ म सरग न कय ) Details of Educational Qualifications: The aggregate Marks of all subjects whether optional, pass course or honors course will be shown in total marks & marks obtained column (Please enclose copies of relevant certificates & Mark-Sheets) CA/ICWA.Preferred : BE/B.Tech.(CSE/IT) /MCA/MSc (CS/IT) श णणक म ग मत Educational Qualification ऩ स ह न क भदहन एव वषट Month & Year of Passing क र अ क Total Marks प र प त क Marks Obtained प रततशत Percentage 10व क क प रभ णऩत र (आम क प रभ ण) 10 th Std. Certificate (Proof of Age) स न तक / Graduation ववश वववद म रम/Name of University : प रथभ सत र /First Semester म व दत म सत र /Second Semester/ प रथभ वषट /First Year त त म सत र /Third Semester त थट सत र /Forth Semester/ म व दत म वषट /Second Year ऩ भ सत र /Fifth Semester छठ सत र /Sixth Semester/ त त म वषट /Third Year स तव सत र /Seventh Semester आठव सत र /Eight Semester/ त थट वषट /Forth Year Ninth Semester Tenth Semester / Fifth Year य र /Total स न तक त तय / ववश वववद म रम/ स स थ /Name of University/ Institute : व द य भ न द मत प र प त /Approved by Govt. : प रथभ सत र /First Semester म व दत म सत र /Second Semester/ प रथभ वषट /First Year त त म सत र /Third Semester त थट सत र /Forth Semester/ म व दत म वषट /Second Year (3)

4 10 अन बव क वववयण (समफद प रभ णऩत र क प रततलरवऩ स रग न कय ) : As per advertisement CRPD/SCO/ /2 अन बव क वववयण (समफद प रभ णऩत र क प रततलरवऩ स रग न कय Experience Details (Please enclose copies of relevant certificates): Minimum 7 years of industry experience in the field of activity based costing /technology consultancy /cost center accounting क र Sl. No. तनम तत क न भ एव ऩत Name & Address of Employer ऩद तथ क भ क वववयण Position and nature of duties स From अवधध/Period तक To वषट एव भ ह Years & Months फ कक ग भ ववश ष श णणक म ग मत / प रलश ण क वववयण : Particulars of any special qualification/training in Banking: 12. (क (ख ख र तथ ऩ ठ मक रभ तय कक रम कर ऩ क वववयण, म सभ आऩन ब ग लरम ह, प र प त ग यव तथ ववलशष र म ग मत Particulars of sports and other extra-curricular activities in which you have participated, Credits & Distinctions obtained : अलबर ध म एव अन द म र ध म Hobbies & other interest: 13. ऩत र व मवह य क लरए ऩ णट वतटभ न ऩत : Present address in full for correspondence: वऩन क : Pin Code: Tel. No. with STD Code Mobile No. 14. ऩ णट स थ म ऩत : Permanent address in full for correspondence: वऩन क : Pin Code: Tel. No. with STD Code Mobile No. Address (4)

5 Address: 15. उन स थ न क वववयण ह आऩ वऩछर ऩ वष क द य न एक वषट म अधधक सभम तक यह ह. Particulars of places where you have resided for more than 1 year during the last 5 years: स From (1) तक To (2) तनव स स थ न क ऩ य ऩत Residential address in full (3) 3 न फय क क रभ भ ददम गए स थ न क म र भ ख म रम District Head Quarter of the place mentioned in the column No. 3 (4) 16. मदद ककस न द म म रम न आऩक ववर द ककस अऩय ध क लरए अलबम न/ दहय सत/ दण / द षलसवद क तनणटम ददम ह त उसक वववयण. Particulars of any prosecution/detention/fine/conviction/sentence against you awarded by any court of law for any offence. 17. मदद ककस न द म म रम भ आऩक ववर द क ई भ भर (फ क/ अन द म ववत त म स स थ ओ क ऋण अद मग नह कयन स स फम न द धत भ भर सदहत) वव य ध न ह त उसक Particulars of cases pending against you in any court of law including case (s) for non-payment of any loan from Banks/ Financial Institutions. 18. मदद ककस स व आम ग, ऩय ण स स थ न अऩन न व ऩय भ आऩक अम ग म घ वषत ककम गम ह / य क, रग त उसक द गम वववयण ह. Particulars of disqualification/ debarment by any Service Commission, examining body at their selection/examination: 19. आऩक वतटभ न अथव ऩहर तनम क (क ) व द य आऩक ववर द प र यमब वव य ध न ककए गए अन श सन त भक / क मटव ह क वववयण, मदद आऩक ककस ऩद न द नतत ऩय भ भ फ ठन ऩय य क रग ई गई ह त उसक ब Particulars वववयण द. of any case (s) of disciplinary action instituted/ pending against you by your present or previous employer (s). Please also state whether you were debarred from appearing in any promotional examination. 20. स रग न रयत र प रभ णऩत र क वववयण 1. Principal of the College /Institute you last attended Particulars of character certificates enclosed (Any Two) : 2. Past /Present Employer 3. Gazetted Officer of State/ Central Govt. MLA, MLC, MP, Branch 4. Branch head of State Bank of India or a Nationalized Bank 21. द प रततम ष ठत ऩरय मक क न भ, व मवस म एव ऩत : Names, occupations and addresses of two respectable referees : क र स Sr. No. न भ Name ऩत Address र र प न न Tel. No. 22. अन द म वववयण फ क क लरए उऩम ग ह सकत ह. Additional particulars, if any, which may be of use to the Bank : (5)

6 23. भ प रभ णणत कयत / कयत ह कक उऩम टतत वववयण भ य ऩ य नक य तथ ववश व स सत म, क सह अन स य व ऩ णट ह. भ ऐस ककस ब फ त स अवगत नह ह भ क न कय क लरए उऩम तत ह न भ फ धक लसद ह सकत ह. भ ब यत भ ककस ब स थ न ऩय अथव ववद श भ स व क लरए अऩन सहभतत द त /द त कयत / कयत ह कक भ झ दह प रततष ध अधधतनमभ 1961 क अ तगटत अथव ववधध क अन स य दण न म ककस अऩय ध क भ भर भ कब दम ण त नह मदद भ य व द य प रस त त ककम गम वववयण गरत म असत म ऩ म त ह औय / म प यभ प रस त त कयत सभम व स तववक तथ म क तछऩ म न फ रत ह त फ क क भ य तनम म तत, तनम म तत क प रस त व सदहत, स ब भ भर ह यद कयन क अधधक य ह ग. उऩय तत वववयण ब यत म स र र फ क क वव स आयऩ /एसस ओ/ /2 ददन क क प रत म तय भ भ य ऑनर इन आव दन क स फ ध भ प रस त त ककए गए ह. I certify that the particulars furnished above are true, correct and complete to the best of my knowledge and belief. I am not aware of any circumstance which might impair my fitness for employment in the Bank. I am willing to serve anywhere in India and in any other country. Further, I declare that I have never been convicted for any dowry offence under the Dowry Prohibition Act, 1961, or any criminal offence under any other law. In case the particulars submitted by me are found to be false or not true and / or suppression of material facts by me while submitting the form is revealed at a later date, the Bank shall have the right to cancel the appointment including the offer for appointment, as the case may be. The above details are submitted in reference to State Bank of India advertisement No. CRPD/SCO/ /2 Dated & my online application thereto. स थ न Place : ददन क Date : अभ मथ क हस त य Signature of candidate : (6)

7 मथ ध त आमत भ सह क ध न द ह रग ए Tick the appropriate box स ऱग नक क स च List of Enclosures स रग न ककम Enclosed 1) Identity proof. [ ] 2) Documentary proof of age [ ] 3) Certificates and Mark sheets of educational qualifications. [ ] 4) Experience certificates [ ] 5) Character Certificates (Any Two) [ ] 6) Brief Resume (3 copies) [ ] 7) NOC from employer [ ] 8) Call letter (Original /Down loaded) [ ] 9) Other qualification (Please specify) [ ] ददन क:. Date : अभ मथ क हस त य Signature of candidate (7)

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