BIO DATA CUM DECLARATION FORM
OF SCRIBE/WRITER
Affix your recent passport size colour photograph &
sign(similar) across so that a part of
the signature spreads over the declaration form and photograph
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{Candidates belonging to visually impaired (VI)
category and whose writing speed is affected by Cerebral palsy (OC) are
required to get filled up this Bio Data Form from his/her Scribe/Writer and
submit it at the time of interview.}
1.Name of Candidate (in Block Letters
leaving one box blank between the parts of your name):
Shri/Smt/Kum :
2.Post :
3. Roll No. :
4.Name of Scribe/Writer (in Block Letters
leaving one box blank between the parts of your name):
Shri/Smt/Kum :
5. Father’s/Husband’s
Name:
6.
Sex:
7.
Marital status
8. Educational Qualifications: (As on 01.12.2011)
Examination/ Degree
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Name of Exam/
Degree passed
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Subjects Studied
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Date, Month
& Year of
Passing
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percentage of Marks obtained
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Name of Board/
University
( Whether Govt./Autonomous)
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Whether recognised
by Govt.
( Yes/No)
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12th
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Graduation
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Post Graduation
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Any Other Qualifications
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9. Computer Knowledge:
Name of the Course
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Subject/Area
covered/Exposed
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Duration
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Date of completion
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Name & address
of the Institution
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Whether recognised
(Yes/No)
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From
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To
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10. Permanent Address: ………………………………………………………………………………………………………………………
(Please mention H No,
Lane/street/Road/Town, Village, Post, Via, Thana, District, State, PIN Code etc)
11. Address for Correspondence:
………………………………………………………………………………………………………….
(Please mention H
No, Lane/street/Road/Town, Village, Post, Via, Thana, District, State, PIN Code etc)
12. Mobile No. …………………….………. Tel. No…………………………….. E-mail ID:
…………………………………………….
13. Have you ever been
debarred from appearing at any examination :
Declaration
I hereby declare that I appeared as a
scribe/writer for the above mentioned candidate in the written examination
conducted by IBPS, MUMBAI and all the statements made above are true, complete
and correct to the best of my knowledge and belief. I understand and agree that
misrepresentation, falsification or omission of material facts or resorting to
any improper means in connection with the selection if found at any stage or
not satisfying the eligibility criteria relating to the academic qualification
of scribe/writer (as on 01.12.11) according to the requirements of the
advertisement for the post may cause candidature/ appointment of the candidate
to be cancelled/ terminated. I understand that the academic qualification
of the scribe should be one grade lower than the stipulated eligibility
criteria for the post and the scribe should possess lesser mark than that of
candidate and not more than 60% marks in my own academic stream.
Last Qualification
possessed : …………………………………………
(Please bring attested
Photostat copy of the Original Mark Sheet & Passing Certificate of Scribe)
Signature of Scribe/Writer as in declaration
form ……………………………………………………………………..
Name :
Date: Signature of
the Applicant ………………………
Place: Name :