Ashok Cbi Form)

1/4/24, 11:24 AM RECRUITMENT OF SAFAI KARMACHARI CUM SUB-STAFF AND/ OR SUB-STAFF 2024-25
Central Bank of India 120122
RECRUITMENT OF SAFAI KARMACHARI CUM SUB-STAFF AND/ OR SUB-STAFF

2024-25
Registration Number : 420202246
Full Name : ASHOK KUMAR

Zone : Lucknow
Region : : Bareilly
State you want to apply for : Uttar Pradesh
Proficiency in the official language of the : Hindi

State/Union territory (i.e. Candidate should
be able to read, write and speak in the
official language of the State/Union
Territory) :
Are you a local resident of the State/Union : YES
Territory you want to apply ?
Had you applied In the Recruitment : NO
Process of Safai Karmachari Cum Sub-
Staff and/ or Sub-Staff Fy 2012-13 in 38
Regions Where Recruitment Process Not
Completed ?
Category : SC
Are you a person with benchmark disability : NO
of 40% and above ?
Type of Disability : -
Sub-Type of Disability : -
Sub-Type of Multiple Disability : -
Are you as per PWBD guidelines eligible to : -
use compensatory time at the time of
examination ?
Are you suffering from cerebral palsy and : -
your writing speed is affected?
If Yes, Do you need compensatory time at : -
the time of examination?
Whether your dominant (Writing) hand is : -

affected?
Do you intend to use the services of a : -
scribe ?
Are you a person with specified disability : NO
covered under the definition of sec 2(s) of
https://ibpsonline.ibps.in/cbiskssnov23/registration_print.php?q=NzM4YjAxOWYyYjY3ZGUzMDBhZWMzYmNjOTdiMWY0ZTB8NDIwMjAyMjQ2 1/5
the RPwD Act, 2016 and not covered under
sec 2(r) of the said act and having difficulty
in writing?
Are you a person with specified disability : -
covered under the definition of sec 2(s) of
the RPwD Act, 2016 and not covered under
sec 2(r) of the said act and wish to avail the
services of Scribe?
I certify that, I will produce the certificate : -
from competent medical authority of a
Government healthcare institution as per
Ministry of Social Justice and
Empowerment, Department of
Empowerment of Persons with Disabilities
(Divyangjan) circular no F. No. 29-6/2019-
DD-III dated 10.08.2022.
Are you an Ex-Serviceman ? : NO
Are you Disabled Ex-Servicemen ? : NO
Period of Service (in months) : -
Date of relief from defence services: : -
Have you joined a Government job on the : -

civil side after availing of the benefits given
as an ex-serviceman ?
Have You already secured employment : -
under the Central Government in Group ‘C’
& ‘D’ will be permitted the benefit of age
relaxation as prescribed for Ex-Servicemen
for securing another employment in a
higher grade or cadre in Group ‘C’/ ‘D’
under the Central Government?
Are you a Dependent of Serviceman killed : NO
in Action (DXS) ?
Are you employee of Central Bank of India : NO
?
If Yes, PF No : -
Are you seeking relaxation under widow / : NO
divorced women / women legally separated
from their husband ?
Religion to which you belong : Hindu
Do you belong to Religious Minority : NO
Community ?
Nationality / Citizenship : Indian
I intend to bring the following ID when : YES
appearing for the examination : (I confirm
my name on this ID and this application
exactly match)
ID Proof : Aadhar Card

ID Proof No. : XXXXXXXX0385
Centre of Examination : Lucknow
Kindly indicate Medium of Paper in : English and Hindi
examination - how you would like the paper
to be presented to you ?
Application Fee / Intimation charges
Payment In : ONLINE
Fees : 148.30
Tax : 26.70 (IGST)
Amount : 175.00
Payment Status : PAID
Reference ID : YHD42193153219
Transaction Date : 04-01-2024
Personal Details
Date of Birth : 20-04-2004
Age completed as on 31.03.2023 : 18
Gender : MALE
Do you have twin brother / sister ? : NO
Name of the twin : -
Gender of the twin : -
Marital Status : Unmarried
Father's Name : JUGENDR
Mother's Name : SAVITRI DEVI
Spouse's Name : -
Address for Correspondence

Address 1 : VILLAGE SHAMBHOOPUR
Address 2 : POST ANAWA
Address 3 : TEHSIL POWAYAN
District : SHAHJAHANPUR
State : UTTAR PRADESH
Pincode : 242401
Permanent address
Address 1 : VILLAGE SHAMBHOOPUR
Address 2 : POST ANAWA
Address 3 : TEHSIL POWAYAN

District : SHAHJAHANPUR
State : UTTAR PRADESH

Pincode : 242401
State for GST invoicing : Permanent Address (UTTAR

PRADESH)
Contact Details
Mobile No : +91 9170776869
Alternative Number : -
(Mobile No/Landline No)
Email ID : [email protected]
Educational Qualification (as on 31.03.2023)
Exam Passed Degree/ Subject / Stream Date of % of Marks Class / Grade

Passing
SSC / Equivalent -- 27-06-2020 67.16 First Class
HSC / Equivalent INTERMEDIATE 18-06-2022 57.60 Second Class
Other Details :
Whether desirous of taking Pre-Exam : YES

Training (SC/ST/OBC/Religious Minority
Community):
Languages Known Read Write Speak
HINDI YES YES YES
ENGLISH YES YES NO
Uploaded Document Details :
1. Left Thumb Impression
2. Hand Written Declaration
Declaration:
I hereby declare that all the 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 untrue or incorrect at any stage or I
am not satisfying any of the eligibility criteria stipulated, and also in case of creating influence/undue pressure regarding
recruitment shall tantamount to cancellation of my candidature.
I confirm that my name as filled by me in the application form exactly matches with the name in my ID proof
• UPLOAD THE
SIGNATURE WITH WHITE
BACKGROUND WITH
BLUE/BLACK INK. YOUR
SIGNATURE IS
ACCEPTED BEYOND
VALID CONDITIONS. IN
CASE OF IDENTITY
CHECK FAILURE AT ANY
LATER STAGE OF THE
PROCESS, IT COULD
LEAD TO
DISQUALIFICATION
Date: 04-01-2024
Left Thumb Impression
Hand Written Declaration

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1/4/24, 11:24 AM RECRUITMENT OF SAFAI KARMACHARI CUM SUB-STAFF AND/ OR SUB-STAFF 2024-25

Central Bank of India 120122

RECRUITMENT OF SAFAI KARMACHARI CUM SUB-STAFF AND/ OR SUB-STAFF

Registration Number : 420202246

Full Name : ASHOK KUMAR

Proficiency in the official language of the : Hindi

Whether your dominant (Writing) hand is : -

Have you joined a Government job on the : -

ID Proof : Aadhar Card

Application Fee / Intimation charges

Address for Correspondence

Address 2 : POST ANAWA

Address 3 : TEHSIL POWAYAN

State : UTTAR PRADESH

State for GST invoicing : Permanent Address (UTTAR

Educational Qualification (as on 31.03.2023)

Exam Passed Degree/ Subject / Stream Date of % of Marks Class / Grade

SSC / Equivalent -- 27-06-2020 67.16 First Class

HSC / Equivalent INTERMEDIATE 18-06-2022 57.60 Second Class

Whether desirous of taking Pre-Exam : YES

Languages Known Read Write Speak

HINDI YES YES YES

ENGLISH YES YES NO

Uploaded Document Details :

1. Left Thumb Impression

2. Hand Written Declaration

SIGNATURE WITH WHITE

BLUE/BLACK INK. YOUR

CHECK FAILURE AT ANY

LATER STAGE OF THE

Left Thumb Impression

Hand Written Declaration

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