Yeejleer³e mìsì बैंक ³eneB HeemeHeesì& DeekeÀej

keÀe neue ner ceW eEKe®ee

ngDee HeÀesìes ef®eHekeÀe³eW
STATE BANK OF INDIA leLee Gme Hej efoveebkeÀ
meefnle HetCe& nmlee#ej
kesÀvêer³e Yeleea SJeb HeoesVeefle efJeYeeie keÀjW
CENTRAL RECRUITMENT & PROMOTION DEPARTMENT Pa ste a recent
passport size
GcceeroJeej keÀe DeelcekeÀL³e SJeb mel³eeHeve HeÀece& photograph here and
CANDIDATE'S BIO-DATA-CUM-ATTESTATION FORM sign across it in full
with date
(ke=ÀHe³ee meeJeOeeveerHetJe&keÀ Heæ{ves kesÀ HeM®eele HeÀece& DeHeveer nmleefueefHe ceW Yejs)
(Please fill in the form in your own handwriting after reading carefully)
Deveg¬eÀceebkeÀ / Roll No. :
Heo keÀe veece / Name of Post :
राज्य / State:
राज्य की अधिकृ त भाषा ( परीक्षा हेत)ु / Official language of state (for test):
मैने अधिकृत भाषा................................. कक्षा दसवी/ बारहवी मे अध्ययन ककया है / I have studied official language…………………..... in 10 /12th standard.
th

1. (keÀ) Hetje veece megmHeä De#ejeW ceW ë

(a) Name in full, in block letters :
Þeer/Þeerceleer /kegÀ. Shri/Smt./Kum. :
(Ke) JewJeeefnkeÀ efmLeefle ë efJeJeeefnle / DeefJeJeeefnle
(b) Marital Status : Married / Unmarried

2. (keÀ) pevce efleefLe

(a) Date of Birth
efoveebkeÀ /Date cenervee / Month Je<e& / Year
(Ke) 01-01-2018 keÀes Gce´ Je<e& cenervee
(b) Age as on 01-01-2018 Year Month
(ie) pevce keÀe mLeeve efpeuee jep³e
(c) Place of Birth District State
(Ie) efpeuee leLee jep³e peneB kesÀ DeeHe efveJeemeer nQ.
(d) District and State to which you belong :
3. (keÀ) jeä^er³elee :
(a) Nationality :
(Ke) Oece& : (ie) ke̳ee DeeHe DeuHemebK³ekeÀ mecegoe³e mes nQ neB /veneR
(b) Religion : (c) Do you belong to Minority Community Yes / No

4. (keÀ) efHelee /Heefle keÀe veece SJeb J³eJemee³e /Heoveece :

(a) Father's / Husband's name and occupation/profession/designation :

(Ke) ceeB keÀe veece ë

(b) Mother's name :

5. (keÀ) ÞesCeer Jeie& (³eLeesef®ele Dee³ele ceW mener keÀe ef®evn ueieeSW) De.pee. De.pe.pee. meeceev³e Dev³e efHeí[s Jeie&
(a) Category (Tick the appropriate box)

SC ST GEN OBC
(Ke) Devegmetef®ele peeefle / Devegmetef®ele pevepeeefle / Dev³e efHeí[s Jeie& kesÀ
GcceeroJeej peeefle/pevepeeefle /mecegoe³e keÀe veece oW
(b) If SC / ST / OBC state the name of
CASTE / TRIBE / COMMUNITY
(ie) ³eefo DeeHe efJekeÀueebie nQ lees ke=ÀHe³ee ³eLeesef®ele Dee³ele ceW mener keÀe ef®evn ueieeSB DeeefmLe efJekeÀ. ¢efä efJekeÀ. ÞeJeCe efJekeÀ
efJekeÀ. pewmes DeeefmLe efJekeÀueebie ³ee ¢efä efJekeÀueebie ³ee ÞeJeCe efJekeÀueebie
(c) If you are physically handicapped, please tick appropriate box.
i.e. LD/OH or VH or HI LD/OH VH HI
(Ie) ³eefo DeeHe MeejerefjkeÀ ©He mes efJekeÀueebie nQ lees ke=ÀHe³ee DeHeves efJekeÀueebielee keÀe efJeJejCe GuuesKe keÀjW
(d) If you are a Physically Handicapped person, please give details of your handicap.
6. (keÀ) ³eefo DeeHe Òel³eeJeefle&le /ÒeJeemeer /efJemLeeefHele J³eeqkeÌle neW lees GmekeÀe efJeJejCe oW.
(a) If you are a repatriate / migrant / displaced person, give particulars :

(Ke) ³eefo DeeHe YetleHetJe& mewefvekeÀ nQ lees ke=ÀHe³ee keÀe³e&cegeqkeÌle /mesJeeefveJe=efÊe keÀer efleefLe keÀe GuuesKe keÀjW.
(b) If Ex-serviceman, please give date of discharge / retirement.
(ie) ke̳ee DeeHe mewv³e keÀe³e&Jeener ces Menero mewefvekeÀ kesÀ DeeefÞele nw leLee GvekeÀes GHeueyOe Deej#eCe nsleg oeJesoej nwb. neB/veneR
(c) Are you a dependant of Serviceman killed in Action and claiming reservation benefits available there under Yes/ No
³eefo Ssmee nw lees DeeHekesÀ oeJes kesÀ ÒeceeCe mJeªHe mebueive omleeJespeeW keÀe efJeJejCe
if so details of documents submitted in support of your claim

1
7. (keÀ) ceele= Yee<ee
(a) Mother Tongue :
(Ke) Debûespeer kesÀ DeefleefjkeÌle Dev³e Yee<eeDeeW keÀe %eeve (हााँ / नहीं )
(b) Knowledge of Languages Other than English (Indicate y e s / No) :

Yee<ee yeesue mekeÀles nw Heæ{ mekeÀles nw efueKe mekeÀles nQ GÊeerCe& Hejer#ee³es, ³eefo keÀesF& nes lees
Language Speak Read Write Examination Passed, if any
1.
2.
3.

8. (keÀ) Mew#eefC ekeÀ ³eesi³eleeS (01.01.2018 को )w ë

(a) Educational Qualifications (as on 01.01.2018) :

GÊeerCe& Hejer#eeS@ mebkeÀe³e keÀe keÀe@uespe DeJeefOe / Period Hejer#eCe cegK³e efJe<e³e efkeÀ³es ie³es ÞesCeer Deewj ÒeeHleebkeÀes keÀe
Examinations GuuesKe keÀjW mketÀue mebmLee Principal Òe³eemees ÒeeHle ÒeefleMele
Passed Indicate College / Examining Subjects keÀer mebK ³ee mLeeve ¬eÀce Percentage
Faculty:Arts/ School No. of Class & of marks
mes lekeÀ body
Science/Comm. From to atte m pts Rank

1 2 3 4 5 6 7 8 9
keÀ#ee
Class X

keÀ#ee
Class XII

mveelekeÀ
Graduation

mveelekeÀesÊej
Post Graduation

Dev³e (efJeJejCe oW)

Other (specify)

9. ÒeeHle HegjmkeÀejeW/HeokeÀeW/íe$eJe=efÊe³eeW keÀe efJeJejCe

Particulars of prizes/medals/scholarships obtained :
10. (keÀ) Kesue leLee Heeþîe¬eÀceslej ef¬eÀ³eekeÀueebHees keÀe efJeJejCe,
efpemeceW DeeHeves Yeeie efue³ee nw, ÒeeHle ieewjJe leLee efJeefMeä
³eesi³elee
(a) Particulars of sports and other extracurricular activities
in which you participated, Credits & Distinctions obtained :
(Ke) DeefYe©ef®e³eeB SJeb Dev³e ©ef®e³eeB
(b) Hobbies & other interests :

11. yeQekf ebÀie ceW efJeMes<e Mew#eefCekeÀ ³eesi³elee/ÒeefM e#eCe keÀe efJeJejCe
Particulars of any special qualification / training in Banking
12. (keÀ) Jele&ceeve leLee Henues kesÀ efve³eespeve keÀe efJeJejCe
(a) Particulars of present and previous employment :

efve³eespekeÀ keÀe DeJeefOe / Period Heo leLee keÀece efve³egeqkeÌle kegÀue Jesleve íes[ves keÀe
veece keÀe efJeJejCe keÀe mLeeve Total Emoluments keÀejCe
SJeb Helee mes lekeÀ Position and Place of Meg© ceW Deble ceW ÒeeHle
From To Nature of Duties Posting Starting Last Drawn
Name & Address of Reasons for
employer leaving

(Ke) Jele&ceeve efve³eespekeÀ keÀer efm Leefle (mejkeÀejer/De×& mejkeÀejer/meeJe&peefvekeÀ #es$e/efvepeer #es$e)
(b) Status of present employer (Govt. / Semi-Govt. / Pub / Pvt. Sector)

2
13. He$e J³eJenej kesÀ efueS HetCe& (Jele&ceeve) Helee 14. HetCe& mLee³eer Helee
Present address in full for communication Permanent address in full :

efHeve keÀes[ efHeve keÀes[

PIN COD E PIN CODE

15. Gve mLeevees keÀe efJeJejCe peneB DeeHe efHeíues Heeb®e Je<eeX kesÀ oewjeve SkeÀ Je<e& mes DeefOekeÀ mece³e lekeÀ jns nes
Particulars of places where you have resided for more than 1 year during the last 5 years :

mes lekeÀ efveJeeme mLeeve keÀe Hetje Helee yeeb³es keÀe@uece ces efoS ieS mLeeve keÀe efpeuee
From To Residential address in full cegK ³eeue³e
District Head quarter of the place
mentioned in the left column

16. ³eefo efkeÀmeer v³ee³eeue³e ves DeeHekesÀ efJe©× efkeÀmeer DeHejeOe kesÀ efueS DeefYe³eespeve/
efnjemele/oC[/oes<eefmeef× keÀe efveCe&³e efo³ee nes lees GmekeÀe efJeJejCe.
Particulars of any prosecution / detention / fine
conviction sentence against you awarded by any court of law for offence.

17. ³eefo efkeÀmeer v³ee³eeue³e ves DeeHekesÀ efJe©× keÀesF& ceeceuee (yeQkeÀ/Dev³e
efJeÊeer³e mebmLeeDeeW keÀer $eÝCe Deoe³eieer vener keÀjves mes mebyebefOele ceeceues
meefnle) efJe®eejOeerve nes lees GmekeÀe efJeJejCe.
Particulars of cases pending against you in any court of law
including case (s) for non-payment of any loan from Banks/
Financial Institution :

18. ³eefo efkeÀmeer mesJee Dee³eesie, Hejer#eCe mebmLee ves DeHeves ®egveeJe Hejer#ee ceW De³eesi³e Ieesef<ele efkeÀ³ee nes
/jeskeÀ ueiee oer nes lees GmekeÀe efJeJejCe.
Particulars of disqualification / debarment by any Service
Commission, examining body at their selection / examination :

19. DeeHekesÀ Jele&ceeve DeLeJee Henues efve³eespekeÀ (keÀes) Üeje DeeHekesÀ

efJe©× ÒeejbYe efkeÀS ieS/efJe®eejeOeerve DevegMeemeveelcekeÀ keÀe³e&Jeener
keÀe efJeJejCe, ³eefo DeeHekeÀes efkeÀmeer HeoesVeefle Hejer#ee ceW yewþves Hej
jeskeÀ ueieeF& ie³eer nes lees GmekeÀe Yeer efJeJejCe oW.
Particulars 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 promotion examination.

20. mebueive ®eefj$e ÒeceeCeHe$eeW keÀe efJeJejCe 1

Particulars of character certificates enclosed 2
1) mketÀue/keÀeuespe DeLeJee Jele&ceeve efve³eesÊeÀe Üeje 1) from school/college or from present employer
2) yeQkeÀ/jepeheef$ele DeefOekeÀejer द्वारा 2) from Bank/ Gazetted Officer

3
21. oes Òeefleefÿle Heefj®ee³ekeÀeW kesÀ veece, J³eJemee³e SJeb Heles
Name, occupations and address of two respectable referees :
¬eÀce mebK³ee veece Helee
Sr. No. Name Addr ess
1.
2.

22. Dev³e efJeJejCe pees yeQkeÀ kesÀ efueS GHe³eesieer nes mekeÀles neW.
Additional particulars, if any, which may be
of use to the Bank :
ceQ ÒeceeefCele keÀjlee/करती ntB efkeÀ GHe³eg&keÌle efJeJejCe cesjer Hetjer peevekeÀejer leLee efJeMJeeme kesÀ Devegmeej mel³e, mener Je HetC e& nQ. ceQ Ssmeer efkeÀmeer Yeer yeele mes
DeJeiele vener ntB pees cegPes yeQkeÀ keÀer veewkeÀjer kesÀ efueS GHe³egkeÌle nesves ceW yeeOekeÀ efme× nes mekeÀleer nw. ceQ ³en Yeer Iees<eCee keÀjlee/keÀjleer ntB efkeÀ cegPes onspe
Òeefle<esM e DeefOeefve³ece 1961 kesÀ Debleie&le DeLeJee efJeefO e kesÀ Devegmeej oC[veer³e efkeÀmeer DeHejeOe kesÀ ceeceues ces keÀYeer Yeer oefC[le vener efkeÀ³ee ie³ee nw.
³eefo cesjs Üeje Òemlegle efkeÀ³ee ie³ee efJeJejCe ieuele ³ee Demel³e Hee³ee peelee nw Deewj/³ee HeÀece& Òemlegle keÀjles mece³e JeemleefJekeÀ leL³eeW keÀe efíHee³ee peevee
yeeo keÀer efleefLe ceW Helee ®euelee nw lees yeQkeÀ keÀes cesjer efve³egeqkeÌle, efve³egeqkeÌle kesÀ ÒemleeJe meefnle, pewmee Yeer ceeceuee nes, jodo keÀjves keÀe DeefOekeÀej nesiee. GkeÌle
efJeJejCe Yeejleer³e mìsì yeQkeÀ kesÀ efJe%eeHeve mebK³ee meerDeejHeer[er/meerDeej/2017-18/10 efo.20.01.2018 Deewj cesjs Dee@veueeF&ve DeeJesove-He$e kesÀ
meboYe& ceW Òemlegle efkeÀ³es ie³es nQ.
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 under the Bank.
Further, I declare that I have never been convicted for 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 latter 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/CR/2017-18/10 dated 20.01.2018 and my online application thereto.

efoveebkeÀ Date : बाएाँ neLe kesÀ Debietþs keÀe efveMeevee DeY³eLeea keÀe nmlee#ej
mLeeve Place : Left Thumb Impression Signature of the candidate

keÀe³ee&ue³e kesÀ GHe³eesie nsleg / FOR OFFICE USE ONLY

(1) ³eesi ³elee/ÒeceeCeHe$eeW keÀe mel³eeHeve Þeer/Þeerceleer Heoveece

Eligibility/Certificates verified by Shri/Smt. Designation :
(2) keÀefce³eeb leLee ÒeeHle efJemebi eefle³eeb ë
Deficiencies and Discrepancies found :

Date: Signature

4
 DECLARATION TO BE SUBMITTED BY THE OTHER BACKWARD CLASSES
CANDIDATES SEEKING RESERVATION AS OBC

I
Son/daughter of Shri
Resident of village/ town/city District
State . Hereby declare that I
belong to the Community which
is recognised as a backward class by the Government of India for the purpose of reservation
in services as per orders contained in Department of Personnel and Training Office
Memorandum No. 36012/22/93-Estt.(SCT) dated 08.09.1993. It is also declared that as
on 10.02.2018, I do not belong to persons / sections (Creamy Layer) mentioned in column
3 of the Schedule to the above referred Office Memorandum dated 08.09.1993.

Place :
Dated (Signature of the candidate)

मैं ____________________________________________________________
पुत्र / पुत्री श्री _____________________________________________________
ननवासी _________________________________________________________
गााँव / कस्बा / शहर _______________________ जिला_____________________
राज्य_______________________________ एतद्द्वारा घोषणा करता / करती हाँ कक मैं
__________________________________ िानत से संबंधित हाँ जिसे भारत सरकार द्वारा
कार्मिक एवं प्रर्शक्षण कायािलय ज्ञापन क्रमांक 36012/22/93-ईएसटीटी (एस सी टी) ददनांक
08.09.1993 मे समाववष्ट आदे शों के अनस
ु ार सेवाओं में आरक्षण के प्रयोिन हे तु एक वपछड़े
वगि के रूप में मान्यता दी गयी है . यह भी घोषणा की िाती है की मैं ददनांक 10.02.2018 को
उपयक्
ुि त संदर्भित कायािलय ज्ञापन ददनांक 08.09.1993 की अनस
ु ची के स्तंभ 3 मे उजखलत त
व्यजक्तयों / ड
ं ों (क्रीमी लेयर) के दायरे मे नहीं हाँ ।

स्थान:
ददनाक: (उम्मीदवार के हस्ताक्षर)