ATTESTATION FORM
1. Name in full First name Middle name Last name
(in CAPITAL letters)
2. Present address At.
P.O.
(As given at the time of Via.
online filled up of P.S.
application) Dist.
State
PIN
3. (a) Permanent At.
address P.O.
(As given at Via.
the time of P.S.
online filled up Dist.
of application) State
PIN
(b) If originally a At.
resident of P.O.
Bangladesh, the Via.
address in that
P.S.
country and the
date of migration Dist.
to Indian union State
PIN
4. RESIDING PERIOD At.
From To P.O.
Via.
P.S.
Dist.
State
PIN
Father’s name in full with full aliases, if any
5. (a) Present At.
address P.O.
(if dead, Via.
give last P.S.
address) Dist.
State
PIN
(b) Permanent At.
address P.O.
Via.
P.S.
Dist.
State
PIN
(c) Profession
(d) If in service, give
designation and official
address
1
6. (i) Nationality of
(a) Self (candidate)
(b) Father
(c) Mother
(d) Husband / Wife
(ii) Place birth of Husband / wife
7. (a) Date of birth
(b) Age as on date
(c) Present Age
(d) Age at Matriculation
8. Place of birth At.
P.O.
Via.
P.S.
Dist.
State
PIN
9. (a) Religion
(b) Category (specify, SC/ST/OBC/GEN)
(c) If, PWD / EX-Serviceman, specify
10. Educational / Professional qualifications showing places of education with years in
Schools and Colleges since 15th year of age
Sl. Name of School / College Date of Date of Examination Date of
with full address admission leaving passed passing
1.
2.
3.
4.
5.
6.
7.
11. If you, have at any time, been employed, give details
Sl Designation of post Period worked Full address of Reasons for
held and Date of Date of the office, farm leaving the
designation of work joining leaving or institution previous service
1
2
12. (a) Have you ever been prosecuted, kept
under detention or bound down / fined,
convicted by a Court of law of any offence
or debarred or disqualified by any public
service commission from appearing at its
examinations / selection?
(b) Is any case pending against you in any
Court of law at the time of filing up this
attestation form?
(c) If the answer ‘Yes’ full particulars of the
case, detention, fine, conviction sentence
etc. should be given
13 Name & address of two responsible 1
persons of your locality or two
references to whom you are known 2
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 or employment
under Bank
SIGNATURE OF CANDIDATE
DATE:………………………….
PLACE…………………………
IDENTITY CERTIFICATE
(Certificate to be signed by any one of the following)
(i.) Gazetted Officers of Central or State Government
(ii.) Members of Parliament or State Legislature
(iii.) Sub-Divisional Magistrates / Officers
(iv.) Tahsildars or Naib / Deputy Tahsildars authorised to exercise magisterial power
(v.) Principals and Head Masters of all recognised institution
(vi.) Block Development Officers
(vii.) Post Masters
(viii.) Panchayat Inspectors
Certified that I have known Shri / Smt. /
Ku……………………………………………………………
Son / daughter of Shri……………………………………………………………..…………for the
last ………………………….years………………..months and that to the best of my knowledge
and belief the particulars furnished by him are correct.
PLACE:………………………
DATE:………………………..
Signature
Designation or status and address
