Attestation Form ZULWH LQWKHFROXPQVLI XQILOOHGWKLVIRU - PDF document

Attestation Form - 1 - IDBI Bank Limited Human Resources Mumbai – 400 005 Attestation Form Warning 1. The furnishing of false information or suppression of any factual information i n the Attestation Form would be a disqualification and is likely to render the candidates unfit f or employment in the Bank. 2. If detained, convicted, debarred, etc. subsequent to the completion and submission of this form, the details should be communicated immediately to the Bank or the authority to whom the attestati on from has been sent earlier, t he case may be, failing which it will be deemed to be a suppression of factual information. 3. If the fact that false information has been furnished or that there has been suppression of any factual information in the attestation form comes to notice at any time during the service of a person, his services would be liable to be terminated without any notice or compensation in lieu thereof. Note: Please fill in the entire form in capital letters appropriately ; write “ Not Applicable ” in the columns if the ent ry is not applicable to you. If any column is left unfilled this form is considered “ incomplete and not valid” . 1. Name in full (in block capitals) with aliases, if any (Please indicate if you have added or dropped at any stage any part of your name or surname.) 2. Present a ddress in full (i.e. Village, Tehsil and District or House Number, Lane/Street/Road and Town). Address District State Pin Telephone 3. (a) Home address /Permanent in full (i.e. Village, Tehsi l and District or House Number, Lane/ Street/ Road and Town and name of District Head quarters. Address District State Pin Telephone (b) If originally a resident of Pakistan, the address in that country and the date of migration to Indian Union. Address District State Pin Telephone Date of Migration (DD/MM/YYYY) : Surname First name Middle name Affix you recent Photograph and sign across the photograph ( 6cm x 7cm ) Attestation Form - 2 - 4 Particulars of place (with periods of residence) where you have resided or more than one year at a time during the preceding five years [Residential address in full (i.e. Village, Tehsi l , & District Or House No. Lane/State/Road &Town)]. In case of stay abroad (including Pakistan), particulars of all places where you have resided for more than one year after attaining the age of 21 years should be given. From:(DD/MM/YYYY) From:(DD/MM/YYYY) Address District Name of District Headquarters State PIN Telephone No From:(DD/MM/YYYY) From:(DD/MM/YYYY) Address District Name of District Headquarters State PIN Telephone No From:(DD/MM/YYYY) From:(DD/MM/YYYY) Address Distr ict Name of District Headquarters State PIN Telephone No From:(DD/MM/YYYY) From:(DD/MM/YYYY) Address District Name of District Headquarters State PIN Telephone No From:(DD/MM/YYYY) From:(DD/MM/YYYY) Address District Name of District Headquarters State PIN Telephone No 5 (a) Name of Father (Name in full with aliases, if any) Nationality (by birth and/or by domi cile) Place of Birth Occupation, if employed give designation & full official address: Present postal address (if deceased, give last address) Permanent Home address (b) Name of Mother (Name in full with aliases, if any) Nationality (by birth and/ or by domicile) Place of Birth Occupation, if employed give designation & full official address: Present postal address (if deceased, give last address) Permanent Home address Attestation Form - 3 - 6 Nationality 7(a) Date of birth (DD/MM/YYYY) 7(b) Present Age 7(c) Age of Matriculation 8. (a) Place of birth, District and State in which situated (b) District and State to which you belong (c) District and State to which your father originally belongs 9. (a) Your Religion ( b) Are you a member of a Scheduled Caste/ Scheduled Tribe? Answer 'Yes' or 'No' and if the answer is 'Yes' state the name thereof. 10. Educational qualification showing places of education with years in Schools and Colleges since 15th year of age Name of School/College with full address Period Examination passed Date of Joining Date of Leaving 11. (a) If you have, at any time, been employed give details : Period (MM/YY ) Designation/Post Held or Job Description Full address of the firm or institution Reason for leaving p ervious service From To (c) Name of wife/husband (Name in full with aliases, if any) Nationa lity (by birth and/or by domicile) Place of Birth Occupation, if employed give designation & full official address: Present postal address (if deceased, give last address) Permanent Home address Attestation Form - 4 - 11. (b) If the previous employment was under the Government of India/s State Government an Undertaking owned or controlled by the Go vt. of India or a State Government/an Autonomous Body/s University/s local Body. If you had left service on giving a month's notice under rule 5 of the Central Civil Services' (Temporary Service) Rules, 1949, or any similar corresponding rules, were any di sciplinary proceedings framed against you, or had you had been called upon to explain your conduct in respect of any matter at the time you gave notice of termination of services, or at a subsequent date, before your were services actually terminated? 12. (a) Have you ever been arrested, prosecuted, kept under detention or bound down/fined, convicted by a court of law for any offence, or debarred/disqualified by any Public Service Commission or any institution from appearing at its examination/select ion or debarred from any examination, rusticated by any University or any other educational Authority/institution? (b) Is any case pending against you in any court of law, University or any other educational authority/institution at the time of fill ing up this attestation form? (If the answer to (a) or (b) is 'Yes', full particulars of the case, arrest, detention, fine, conviction, sentence etc., and the nature of the case pending in the Court/University/Educational authority etc., at any time of filing up this form should be given.) 13. Name and addresses of two responsible persons of your locality or two references to whom you are known. Name (in full) Address District State Pin Telephone Name (in full) Address District State Pin Telephone ……………………………………………………………………………………………………………………………………………………………………………………………… I certify that the foregoing information is co rrect and complete to the best of my knowledge and belief. I am not aware of any circumstances, which might impair my fitness for employment under Government/Bank. Date : Place : (Signature of candidate) Attestation Form - 5 - Identity Certificate Certified that I have known Shri/Shrimati/Kumari …………………………………………son/daughter of Shri………………………………………………………. for the last …………………years ……………….. months and that to the best of my knowledge and belief the particulars furnished by him/her are correct. S ignature ……………………………………………………….. Designation & Status & Address ……………………………………………………………………………….. ……………………………………………………………………………….. ……………………………………………………………………………….. (Rubber stamp of office) Place: Date: P.S. The Photog raph of the candidate to be attest ed by the competent authority. Certificate to be signed by any one of the following: - Gazetted Officers of Central or State Government; Members of Parliament or State Legislature belonging to the Constituency where the candidate or his parent/guardian is ordinarily resident; Sub - Divisional Magistrates/Officers; Tehsildars or Naib/Deputy Tehsildars authorised to exercise registrar(s) powers; Principals and Head Masters of the recognised School/College/Institution wher e the candidate studied last; Block Development Officers; Post - Masters; and Panchayat Inspectors. ……………………………………………………………………………………………………………………………………………………………………………………………… TO BE FILLED BY THE OFFICE Name, designation and address of the appointing authorit y: IDBI Bank Ltd. Post of which the candidate is being considered. : Affix signed passport size Photograph