REV-ANNEXURE-I
FOR SPECIMEN SIGNATURE INDEX NUMBER
Date:_____________
NAME: SHRI/SMT/MS : _______________________________________________________________
(ALL IN CAPITAL LETTERS) SURNAME NAME FATHER’S/HUSBAND’S NAME
IN WHICH ALPHABET YOU DESIRE TO HAVE YOUR INDEX NUMBER:_______
EMPLOYEE NO.__________________ DATE OF JOINING_______________________________
DATE OF BIRTH__________________ DATE OF RETIREMENT___________________________
DESIGNATION____________________ SCALE________________________
PLACE OF POSTING (NAME OF THE BRANCH/OFFICE)___________________________________
BRANCH BSR CODE REGION CODE ZONE CODE
WHETHER POWER OF ATTORNEY HOLDER: YES/NO
IF YES, CATEGORY:_________________
DATE OF PROMOTION/PLACEMENT TO PRESENT SCALE/POST______________
THIS IS CERTIFY THAT THE ABOVE MEMBER’S SIGNATURE IS NOT REGISTERED IN THE SPECIMEN
SIGNATURE ALBUM AND THAT HE/SHE HAS NOT BEEN ALLOTTED ANY INDEX NUMBER HITHERTO AND IT IS
FURTHER CERTIFIED THAT THE ABOVE MEMBER DOES NOT FIGURE IN ANY GROSS IRREGULARITY
INVOLVING MALADES AND NO DISCIPLINARY PROCEEDINGS ARE CONTEMPLATED/PENDING OR
CONCLUDED AGAINST HIM/HER, ON ACCOUNT OF ANY IRREGULARITIES.
______________________________ ________________________________
ATTESTED BY (SIGNATURE, NAME AND INDEX NUMBER OF ATTESTING
DESIGNATION –SCALE & EMPLOYEE NO. OFFICER
(MEMBER TO SIGN WITH BLACK PEN AND WITHIN THE CAGE ONLY)
NAME :_______________________________ NAME:______________________________
If signature is to be revised quote your Index Number : ___________________
__________________________ _____________________________
REGIONAL MANAGER CM/AGM/Zonal Office
Name & Index No. Name & Index No,
N.B. : The branches and controlling offices should affix their respective rubber stamps on the applications.