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ON-LINE APPLICATION FOR SINGLE WINDOW OPERATOR(SWO)

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Please paste your recentpassport size photographand sign across it. Pleaseretain atleast 5 copies of same photograph with youfor subsequent use.

Registration #: 3236334

Full Name: VEANKTESHWAR CHATURVEDI

Category : SC

If Person with Disability : NO

Type of Disability : -- Percentage of Disability : --

Do you intend to use the services of a scr ibe (only for VI & OCcandidates whose writing speed is affected by cerebral palsy)?:

NO

Whether domiciled in Kashmir Division of the Stateof J & K during the period 1-1-1980 to 31-12-1989 ?

NO

Whether you belong to Religious Minority Community? : NO

Religion to which you belong : --

Whether Children / Family members of those who died in 1984 riots ? : NO

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 s eeking relaxation under widow/divorced women/

women judicially Separated from their husbands and who arenot re-married :

NO

Nationality : INDIAN

State / Union Territory for which you are applying : Chattisgarh

State code : 19

Centre of Examination : Bhopal

Centre code : 30

Application Fee / Postal Charges Details :

Transaction ID : M4403902

Branch Name : PNB SADAR BAZAR BILASPUR

Branch Code : 005800

Date of Deposit : 30-04-2011

Amount : 50

Personal Details :

Date of Birth : 04-01-1987

Age as on 01.01.2011: 23

Gender : MALE

Father's Name / Husband's Name : BHAGWAT PRASD CHATURVEDI

Mother's Name : MEENA BAI CHATURVEDI

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Address for Correspondence : GURU GHASI DAS NAGAR TIRANGA

CHOWK KUSHALPUR RAIPUR (C.G)

District RAIPUR

State : CHHATTISGARH

Pin : 492001

Permanent Address : GURU GHASI DAS NAGAR TIRANGA

CHOWK KUSHALPUR RAIPUR (C.G)

District RAIPUR

State : CHHATTISGARH

Pin : 492001

Contact Details:

Phone No : -

Mobile No: 9827996191

Email ID : veank_chaturvedi@yahoo.co.in

Qualification Details (as on 11.04.2011) :

Exam Passed Subject/Stream Year of Passing % of Marks

Graduation BE IN ELEX ENGG 2011 7.10

Working Knowledge of MS Office : YES

Other Details :

Would You like to undergo Pre-Exam Training (SC/ST/MinorityCommunity/ Ex-Servicemen/ Physically Challenged) :

YES

If Yes Centre for Training : Bhopal

Languages Known Read Write Speak

HINDI YES YES YES

ENGLISH YES YES YES

DECLARATION: I hereby c ertify that the above information furnished is correct to the bes t of my knowledge and belief. I have not suppressed any material fact orfactual 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 donot satisfy the eligibility cr iteria according to the advertisement, then my candidature will be rejected/ service terminated even after permanent employmentwithout giving any notice or reasons thereof.

I hereby c ertify that I am satisfying the eligibility criteria for the post applied for in terms of advised criteria in respect of age, caste, educationalqualification etc.

I hereby agree that any legal proceeding in respect of any matter or claims or disputes arising out of application or out of s aid advertisement canbe instituted by me only at New Delhi and courts / Tribunal/ forums at New Delhi only, shall have sole and exclusive jurisdiction to any cause/ dispute. Iundertake to abide by all the terms and conditions in the advertisement given by the Bank.

Place:

Date: 01-05-2011 Signature of Applicant

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

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