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 # : Full Name : Category : Person With Disability : Type of Disability : Do you intend to use the services of a scribe (only for VI & OC candidates whose writing speed is affected by cerebral palsy)? Are you a candidate who had ordinarily been domiciled in Kashmir Division of the State of J&K during the period 1-1-1980 to 31-12-1989 : Whether you belong to The Children/Family Members of Those who had died in 1984 Riots: Are you an Employee of Vijaya Bank? Employee Number/ Staff Code: Whether you belong to Religious Minority Community? Religion to which you belong : Are you an Ex-Serviceman ? Nationality : Choice of Centre for Examination : : Centre code : Application Fee / Postal Charges Details : Transaction ID : Branch Name : Branch Code : Deposit Date :

NAVNEETH VASU KOTIAN UR NO Percentage of Disability : --



NO NO NO Applying for higher grade/scale? -

NO INDIAN Mumbai 22

0139057 BORIVALI 5047 13/10/2010 Amount : 300

Personal Details :
Date of Birth : Gender : Father's Name/ Husband's Name : Mother's Name : February 03,1986 MALE VASU KOTIAN LALITHA VASU KOTIAN Age as on 30.06.2010: 24

Contact Details:
Email ID : Address for Correspondence : navneetkotian@gmail.com 73/10 - A NALANDA VAN CHS MITTAL ENCLAVE JUCHANDRA NAIGAON EAST

I agree that the Bank has the right to post me to any part of the country at its discretion. I am willing to serve anywhere in India. 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 the requirements of the advertisement my candidature/appointment is liable to be cancelled/terminated at any stage and if appointed my services are liable to be terminated.08 Would You like to undergo Pre-Exam Training (Only for SC/ST/Minority Community) : If Yes centre for training : Other Details : Languages Known ENGLISH HINDI TULU KANNADA Read YES YES YES YES NO Write YES YES NO NO NO Speak YES YES YES YES NO DECLARATION: I hereby declare that the statements made in this application are true.2010): THANE MAHARASHTRA Pin : Mobile No : 401208 9892367224 Pin : 401208 Exams Passed Graduation : Knowledge of Computer : Subject/Stream BMS YES NO Month/Year Of Passing 05/2007 % of Marks 67. and Password (sent to your Email ID) carefully for further reference. I hereby agree that any legal proceeding in respect of any matter(s) or claims or disputes arising out of application or out of said advertisement can be instituted by me only at Bangalore and Courts / Tribunal /Forums at Bangalore only shall have sole and exclusive jurisdiction to try any cause/dispute. complete and correct to the best of my knowledge and belief.06.A NALANDA VAN CHS MITTAL ENCLAVE JUCHANDRA NAIGAON EAST District State : Phone No : Educational Qualification Details (as on 30. I undertake to abide by all the terms and conditions mentioned in the advertisement given by the Bank.2/2 District State : Permanent Address : THANE MAHARASHTRA 73/10 . Place: Date: 14/10/2010 Signature of Applicant NAVNEETH VASU KOTIAN Please retain your Registration No. . Note : Please do not send the application print out to the Bank.