ATTESTATION FORM
Photo
The furnishing of false information or suppression of any factual information in the Attestation Form
would be a disqualification and is likely to render the candidate unfit for appointment in the Bank. If
the fact that false information has been furnished or there has been suppression of any factual
information in the Attestation Form comes to notice any time during the service of person, his/her
service would be liable to be terminated.
Name in full (in Block letters) with SURNAME FIRST NAME MIDDLE NAME
aliases if any (Please indicate if you have
1.
added or dropped at any stage any part
of your name or surname)
Present address in full (i.e. Village, Thana
and District or House No. Lane/ Street/
2. Road and Town)
a) Home address in full( i.e. Village,
Thana and District or House No. Lane/
Street/ Road /Town and name of the
3. District Head Quarter)
b) If originally a resident of country other
than India, the address in that Country
and the date of migration to India Union.
4. Particulars of places (with period of residence) where candidate has resided for more than one
year
at a time during the preceding five years.
Name of the District Head
Residential address in full (i.e. Village, Thana
Quarters of the place
From To and District or House No. Lane/ Street/ Road/
mentioned in the
Town)
preceding Column
5.1
a) Father’s name in full, with alias, if any
b) Present postal address of Father
(If dead, give last address)
c) Permanent Home Address
d) Profession
e) If in service, give designation and
official address
5.2
a) Husband’s name in full
b) Profession
c) Designation and office address
-2-
6. Nationality of : a. Father b. Mother c.Husband/Wife
7. a. Date of Birth : b. Present Age:
c. Age at Matriculation
8. a. Place of Birth : (District and state in which situated)
b. District and State to which you belong
9. a. Religion :
b. Are you a member of Scheduled Caste/ Tribe/ Yes/No
OBC
If yes, state the name thereof
10. Educational Qualifications showing place of Education with years in School and Colleges since
th
15 year of Age
Name of School/ College of full Date of Date of Examination Year of
address entering leaving passed passing
11. If you have, at any time, been employed, give details
Full address Reason for
Name of Designation of post & Period of the leaving the
Employer Description of work office/firm job
From To
12. Have you ever been arrested or kept under detention or bound down/fined/convicted by a Court
of law for any offence OR any case pending against you for any offence/s OR debarred/disqualified
by the Public Service Commission from appearing at its examination selections or debarred from
taking any examination or rusticated by authority/institution?
If answer is Yes, full particulars of the case, detention, fine conviction sentence etc. should be
given.
DECLARATION
I, certify that the foregoing information is correct and complete to the best of my knowledge and
belief. I am not aware of any circumstances which might impair my fitness for employment in the
Bank. I have/will have no objection to the Bank making enquiries at any time regarding the statements
made by me in the application, in any manner they decide to do so, including police inquiry into my
antecedents.
Date : Signature of Candidate
Roll No.: _______________________
Post : _______________________
Process: _______________________
