Академический Документы
Профессиональный Документы
Культура Документы
Provisionally allotted for the post of Office Assistant (M)/ Officer Scale-I / Officer Scale- II reported at
Baroda Rajasthan Kshetriya Gramin Bank, Head office, Ajmer for Pre-Joining formalities and submitted
following Forms/ Documents duly attested by me.
F-11
F-12
F-13
9. igpku dk fpUg
Identification Mark : ______________________________________
10. D;k vki cSad ds fdlh funskd ;k deZpkjh
ds fjrsnkj gS \ ;fn gks] d`i;k ,sls O;fDr
dk iwjk C;kSjk] cSad esa mldh gSfl;r rFkk
D;k fjrk gS] ;g nkkZ,a
Are you a relative of any Director : ______________________________________
or the employee of the Bank? If so, ______________________________________
please give the full name of such ______________________________________
person, his position in the Bank & ______________________________________
nature of relationship.
11. ewy fuokl dk LFkku Place of Domicile : ______________________________________
12. vius kS{kf.kd dk;Zdky ds nkSjku ;fn
vkius dksbZ O;ogkfjd izfk{k.k fy;k gks]
rks mldk C;kSjk nsAa
Give details of any practical training : ______________________________________
you had as a part of your academic ______________________________________
career / training ______________________________________
..2
F-1
(2)
13. D;k vkidks fdlh izdkku dk Js; feyk gS\
isilZ] ys[k bR;kfn ;fn gks] d`i;k C;kSjk nsAa
Have you any publication to your : ______________________________________
credit (Papers, articles, etc.) ? If so, ______________________________________
please give details. ______________________________________
14. D;k vki vkxs fdlh ikB~;e gsrq v/;;u
dj jgs gSa\ ;fn gkWa] d`i;k C;kSjk nsAa
Are you studying for any further : ______________________________________
course ? If so, please give details. ______________________________________
15. D;k vki fdlh O;olkf;d@jktdh; fudk;@
fudk;ksa ds lnL; gS\ ;fn gkW] d`i;k C;kSjk nsAa
Are you, a member of any professional /: _____________________________________
political body / bodies ? If yes, please _____________________________________
give details. _____________________________________
16. D;k vkius fonsk ;k=k dh gS@;fn gks]]
d`i;k mldk m)s;] vkids fonsk esa jgus
dh vof/k rFkk dksbZ vuqHko vftZr fd;k gks]
rks mldk C;kSjk nsAa
Have you traveled abroad ? If so, : ______________________________________
please give details about the purpose, ______________________________________
duration of your stay abroad, any ______________________________________
experience gained etc. ______________________________________
17. D;k vki dHkh fxjrkj gq, gSa vFok vfHkj{kk
esa j[ks x, gSa vFkok fdlh U;k;ky; }kjk
vkc) fd;s x, gSA vki ij tqekZuk yxk;k
x;k gS ;k fdlh ijh{kk esa cSBus ij jksd
yxk;h x;h gSA vki v;ksX; ?kksfkr fd;s x,
gS vFkok fdlh izkf/kdkjh@laLFkku }kjk dksbZ
izfrca/k yxk;k x;k gS\ ;fn gkWa] rks iw.kZ nsAa
Have you ever been arrested or kept : ______________________________________
under detention or bound/fined/ ______________________________________
convicted by court of law or debarred/ ______________________________________
disqualified from any examination or ______________________________________
restricted by any authority / Institution? ______________________________________
If yes, give full details.
18. vU; dksbZ lwpuk tks vki nsuk pkgsaA
Any other information you would like : ______________________________________
to give. ______________________________________
19. eSa fdlh Hkh LFkku ij tgkWa cSad dh kk[kk ;k
dk;kZy; gS ;k vc ds ckn [kksyh tk,] esa cSad
dh lsok djus gsrq bPNqd gwa vkSj eSa cSad
}kjk le;≤ ij r; dh tkrh lsok krksZa
ls vkc) jgus gsrq lger gwAa eSa uksV djrk gW]aw
fd ifjoh{kk dh vof/k ds nkSjku esjh lsok,a cSad }kjk
fcuk fdlh dkj.k n'kkZ, lekIr dh tk ldsxhA
I am willing to serve the Bank anywhere the Bank
has or might hereafter open office or branches
and agree to be bound by the terms and
conditions of services laid down by the Bank
from time to time.I note that during the period
of probation, my services are liable to be
terminated by the Bank without assigning
any reason whatsoever for such termination.
..3
F-1
(3)
eSa ,rn~}kjk lger gksrk gw]a fd eq>s vkids }kjk lsok esa fy;s tkus ij] cSad ;k mlds xzkgdksa ds ekeyksa ls
lacaf/kr dksbZ Hkh tkudkjh esjs ikl gksxh] mls eSa vR;Ur xksiuh; j[kwx
a k vkSj fdlh Hkh le; fdlh ds le{k
mls izdV ugha d:axkA
I hereby agree that in the event of my being taken up in your services, any information
concerning the affairs of the Bank or its clients of which I may become possessed, shall be
held by me in strict confidence and shall not be divulged to anyone at any time.
eSaus mDr QkWeZ rFkk ckW;ksMsVk QkWeZ Hkjk gS vkSj eSaus ml ij lko/kkuh ls fopkj djrs gq, vkSj le> dj
opu fn;k gS rFkk ,rn~}kjk Hkh eSa ?kksfkr djrk gwWa] fd esjs mDr nksuksa izksQkWekZ esa nh tkudkjh lR; gS rFkk
esjh tkudkjh ,oe~ fookl ls lgh gSA
I have filled in the above form and have given the undertaking after carefully considering and
understanding it and I hereby declare that the information given by me in both these forms is
true and correct to the best of my knowledge and belief.
eSa vkxs bl ckr ds fy, Hkh lger gwWa] fd esjs }kjk mDr QkWeZ rFkk ckW;ksMsVk QkWeZ esa nh xbZ] ftl
tkudkjh ds vk/kkj ij cSad }kjk esjh fu;qfDr dh xbZ gS] og xyr ik;h tkrh gS] rks mls ,d xaHkhj
dnkpkj ekuk tk,xk vkSj blls cSad esa esjh lsok,a] rRdky c[kkZLr dh tk ldsxhA
I further agree that in the event of any information given by me in the above form and bio-
data form, on the basis of which my appointment is considered by the Bank, is found to be
false, it will constitute serious misconduct which will render me liable to immediate
dismissal from the Banks service.
LFkku %
Place : ________________________
fnukad %
Date :_________________________
gLrk{kj @ Signature
iwjk uke %
Full Name :_________________________
eksckbZy ua-:_________________________
bZ&esy irk:_________________________
F-2(SC/ST)
I__________________________________son/daughter/wife of _________________
_______________resident of village/town/city________________________
Scheduled caste / Scheduled Tribe by the Government of India for the purpose of
material for the purpose of this appointment. If the any information contained in
misrepresentation/ supersession.
(Name _________________________)
Mobile No.______________________
Place: ____________
Date : ____________
F-2(OBC)
I__________________________________son/daughter/wife of shri______________
_____________________resident of village/town/city________________________
material for the purpose of this appointment. If the any information contained in
misrepresentation/ supersession.
(Name _________________________)
Mobile No.______________________
Place: ____________
Date : ____________
F-3
SCHEDULE I
Ground:
2. I solemnly affirm that the above declaration is true and I understand that
in the event of the declaration being found to be incorrect after my
appointment, I shall be liable to be dismissed from service.
I further declare that I will not divulge or allow to be divulged to any person not
legally entitled thereto any information relating to the affairs of the said Bank or
to the affairs of any person having any dealing with the said Bank and nor will I
allow any such person to inspect or have access to any books or documents or
electronic records belonging to or in possession of the said Bank and relating to
the business of the said Bank or the business of any person having any dealing
with the said Bank.
Signature:
Place : Name in full:
Date : Designation:
Signature:
Name in full:
Designation:
E.C.No. :
F-5
SCHEDULE III
DECLARATION OF DOMICILE
Date : Signature :
Place : Name :
Designation :
UNDERTAKING
(FOR EX-SERVICEMAN)
2. I confirm that I have not at any time prior to this appointment, secured any
employment on the civil side (including Public Sector Undertakings, Autonomous
Bodies/Statutory Bodies, Nationalized Banks, etc.), by availing of the concession
of reservation of vacancies admissible to Ex-servicemen.
Place :
Date : Signature of candidate
Name : __________________________
Address : ________________________
_________________________________
_________________________________
F-7
Letter of Undertaking
I, ______________________________________________________________________
S/o.______________________________R/o.(Res.Add)_________________________
The said documents submitted by me shall be deemed to be material for the purpose of this
appointment.
I hereby state that I fulfill the prescribed eligibility criteria and all the copies of documents /
certificates submitted by me are correct and in order and shall be deemed to be material for
the purpose of selection.
I undertake that the documents, information, statements and claims are true to best of my
knowledge. In case, any thing is found to be false and/or incomplete resulting in non-
fulfillment of eligibility criteria as prescribed, my candidature / appointment would be treated
as void ab-initio and the services are liable to be terminated, as having been secured on
mis-representation, false representations and / or suppression of facts with a motive to gain
employment.
(Name _________________________)
Place: ____________
Date : ____________
F-8
Report of Referees
(1) ___________________________________
___________________________________
___________________________________
___________________________________
Mobile No.___________________________
(2) ___________________________________
___________________________________
___________________________________
___________________________________
Mobile No.___________________________
Place :
Date : Signature of candidate
Name : __________________________
Address : ________________________
_________________________________
_________________________________
BARODA RAJASTHAN KSHETRIYA GRAMIN BANK
(HEAD OFFICE : AJMER)
_____________________________________________________________________
_____________________________________________________________________
COMPLAINT
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________
3. Qualification:
4. Fathers Name and Occupation:
5. Caste:
6. Complete Home Address:
7. Present Address:
8. Mobile No. :
9. E-Mail Address :
11. Height :
Place:
Date: Signature and Designation of the Verifying Officer
F-10
BARODA RAJASTHAN KSHETRIYA GRAMIN BANK
(HEAD OFFICE : AJMER)
lR;kiu QkWeZ
ATTESTATION FORM
.. 2
F-10
(2)
5.1 d firk dk iwjk uke miuke ds lkFk] ;fn dksbZ gks rks
(a) Fathers Name in full with alias, if any : _________________________________
[k orZeku Mkd irk
vxj e`R;q gks xbZ rks vafre irk : _________________________________
(b) Present Postal Address _________________________________
(If dead, give last address) __________________________________
_________________________________
x LFkk;h irk (c) Permanent Address : _________________________________
_________________________________
_________________________________
_________________________________
?k iskk (d) Profession : _________________________________
M- vxj lsok esa gS] rks inuke vkSj dk;kZy; irk : _________________________________
(e) If in service, give designation and _________________________________
official address _________________________________
5.2 d ifr@ifRu dk iwjk uke
(a) Spouses name in full : _________________________________
[k iskk
(b) Profession : _________________________________
x inuke vkSj dk;kZy; irk
(c) Designation and Office Address : _________________________________
_________________________________
_________________________________
6. ukxfjdrk @ Nationality of
d firk @(a) Father : _________________________________
[k ekWa @ (b) Mother : _________________________________
x ifr@ifRu (c) Spouse : _________________________________
7. ;FkkZr tUe frfFk Exact date of Birth : _________________________________
orZeku vk;q @ Present Age : _________________________________
eSVhd ds le; vk;q Age at Matriculation : _________________________________
8. d tUe LFkku (a) Place of Birth : _________________________________
ftyk vkSj jkT; tgak fLFkr gS
(Distt. & State in which situated) _________________________________
[k ftyk vkSj jkT; tgak ds jgus okys gks
(b) Distt. & State to which you belong : _________________________________
9. d vkidk /keZ (a) Your Religion : _________________________________
[k D;k vki vuq-tkfr@vuq-tutkfr ds lnL;
gS\ vxj mRrj gkWa gS] rks bldk uke crk,a
(b) Are you a member of a Scheduled Caste /: _________________________________
Scheduled Tribe ? If the answer is yes, _________________________________
state the name thereof.
10. kS{kf.kd;ksX;rk,a] ftlesa 15 lky dh vk;q ls ysdj fk{kk dk LFkku o okksZa ds lkFk Ldwy vkSj dkWyst
dk LFkku nkkZ;k x;k gksA
Educational qualifications showing place of education with years in Schools and
Colleges since 15th year of age.
iwjs irs ds lkFk izosk djus dh NksM+us dh rkjh[k mRrh.kZ djus dk okZ
Ldwy@dkWyst Name of rkjh[k Date of leaving Year of Passing
School/College with full Date of entering
address
.. 3
F-10
(3)
11. ;fn vki fdlh Hkh le; lsok esa jgs gSa] rks mldk fooj.k nsA
a
If you have, at any time, been employed, give details.
/kkfjr in dk uke] vof/k Period dk;kZy;] O;olk; lsok dks NksM+dj
fuikfnr dk;Z izfrBku ;k laLFkku tkus dh otg
Designation of
ls @ From rd @To dk iwjk irk Reasons for
post held of Full address of the leaving the job
description of Office, Firm or
work Institution
12. D;k vkidks dHkh fxjrkj fd;k x;k gS] utjcanh fd;k x;k gS ;k fdlh vijk/k ds fy, vkidks fdlh
U;k;ky; }kjk izfrcaf/kr fd;k x;k gS@tqekZuk yxk;k x;k gS@ltk nh xbZ gS vFkok la?k yksd lsok
vk;ksx }kjk ijh{kk esa Hkkx ysus ij jksd yxkbZ gS\ ;k vkidks foofo|ky;@ izkf/kdj.k@laLFkk ls
izfrcaf/kr@fdlh Hkh ijh{kk esa cSBus ls oftZr@fu"dkflr fd;k x;k gks\
vxj mRrj ^gkWa* gS] rks dsl dk iwjk C;kSjk] tqekZuk] nksk flf)] n.Mknsk vkfn dk mYys[k djsAa
Have you ever been arrested or kept under detention or bound down / fined / convicted
by a Court of Law for any offence or debarred / disqualified/restricted by the Public
Service Commission from appearing at its examination selections or debarred from
taking any examination or restricted by University/authority / institution ?
If answer is YES full particulars of the case detention, fine, conviction, sentence etc.,
should be given. ______________________________________________________
____________________________________________________________________________
13- D;k bl vuqizek.ku QkeZ dks Hkjrs le; fdlh Hkh U;k;ky; fo'ofo|ky; ;k fdlh Hkh 'kS{kf.kd
izkf/kdj.k@laLFkk esa vkids fo:) dksbZ ekeyk yfEcr gS ;fn d vFkok [k esa iwNs x;s iz'uksa ds
laca/k esa vkids mkj gk esa gks rks vkidks bl vuqizek.ku QkeZ Hkjrs le; ekeys] fxjrkjh] fujks/k
tqekZus] nks"kfl) rFkk n.Mkns'k vkfn ds iwjs C;kSjs izLrqr djus pkfg,A rkfd bl QkeZ dks Hkjrs le;
U;k;ky;@fo'ofo|ky;@'kS{kf.kd izkf/kdj.k vkfn ds le{k tks ekeyk yfEcr gks mldk Lo:i
crykuk pkfg, bl tkudkjh ds vfrfjDr tgka ykxw gks ogka fuEufyf[kr C;kSjs Hkh fn;s tk;sx%sa &
ekad en gk@uk ;fn gk] rks fooj.k Hkh nsa
1 vijk/k@vkjksi
2 iqfyl Fkkus esa iathc)
3 ;fn U;k;ky; esa pkyku izLrqr fd;k x;k gks rks U;k;ky; dk
uke
.. 4
F-10
(4)
;fn bl QkeZ dks Hkjus vkSj Hkstus ds ckn mEehnokj dks utjcan ;k fxjrkj fd;k tkrk gS vFkok ml ij
eqdnek pyk;k tkrk gS ;k mls canh cuk;k tkrk gS rks vFkok ml ij tqekZuk fd;k tkuk ;k mls nks"k
fla) ik;k tkrk vFkok mls fooftZr fd;k tkrk gS ;k nks"keqDr fd;k tkrk gS rks C;kSjs ;FkkfLFkfr] jkT;
yksd lsok vk;ksx ;k ml izkf/kdkjh dks ftls vuqizek.ku QkeZ igys Hkstk x;k gks] rRdky lwfpr fd;s tkus
pkfg;s vFkok ;g ekuk tk,xk fd rF;kRed tkudkjh fNikbZ xbZ gS] vr% ;g Lo;a mEehnokj ds fgr esa
gksxk fd og mu ekeyksa ds iwjs C;kSjs izLrqr djs]a ftuesa mls fxjrkj fd;k x;k Fkk] ml ij vfHk;kstu
pyk;k x;k Fkk] vkfn Hkys gh ekeys esa vfUre :i ls izfrosfnr dj fn, gks [kkRek okil ys fy, gks ;k
muesa vUrr% nks"keqfDr gks xbZ ;k le>kSrk dj fy;k x;k gksA
;fn rF; fd vuqizek.ku QkeZ esa vlR; tkudkjh nh xbZ gS ;k ;g fd dksbZ rF;kRed tkudkjh fNikbZ xbZ
gS] fdlh O;fDr dh lsok ds nkSjku fdlh Hkh le; /;ku esa vk, rks] mldh lsok,a lekIr dh tk ldsx
a hA
DECLARATION
eSa] izekf.kr djrk@djrh gwWa] fd iwoksZDr lwpuk esjh loksZre tkudkjh vkSj fookl ds vuqlkj lgh vkSj iw.kZ
gSA eSa ,slh fdlh ifjfLFkfr ls ifjfpr ugha gwa] tks eq>s cSad esa jkstxkj gsrq esjh ;ksX;rk dks {kfr igqapk
ldrh gSA esjs vkosnu i= esa esjs }kjk fn;s x, dFku ds laca/k esa iqfyl tkap iM+rky lfgr cSad }kjk dksbZ
Hkh tkap dHkh Hkh fdlh Hkh le; rqjar@fudV Hkfo; esa ij djus esa eq>s Hkh vkifRr ugha gSA
I certify that the foregoing information is correct and complete to the best of my knowledge
and belief. I am not aware of any circumstance which might impair my fitness for
employment in the Bank. I have / will have no objection to the Bank making enquiries at any
time (immediately / in the near future) regarding the statement made by me in the application.
In any manner they decide to do so inclusive of police enquire into my antecedents.
2. firk dk uke
Fathers Name :_______________________________
3. tUe frfFk
Birth Date :_______________________________
6. v kS{kf.kd ;ksX;rk
(a) Academic Qualification + :_______________________________
8. Hkkkkvksa dk Kku
Languages known
9. dk;Zxzg.k dh rkjh[k
Date of Joining Service :_______________________________
. 2
(2)
vf/kdkjh @Officer
d-dw-la- E.C.no.
(To be submitted at the time of joining by Office Assistant)
INDEMNITY BOND WITH SURETY
(To be stamped of Rs. 1000/- as per State Stamp Rules and Notarized)
(2)
WHEREAS the Selected candidate has been selected for appointment as Office Assistant
(Multipurpose) in the service of the Employer Bank.
WHEREAS an Offer of Appointment containing the terms and conditions of the appointment
as Office Assistant (Multi-purpose) has already been issued to the Selected candidate
vide letter No. HO/2017-18/HRM/......... dated . . . . . . . .. of the Employer Bank.
WHEREAS the acceptance of the terms and conditions of the appointment has already
been communicated to the Employer Bank on dated ________________ by the Selected
candidate.
WHEREAS one of the terms and conditions of the appointment is that the Selected
candidate has to serve the Employer Bank i.e. Baroda Rajasthan Kshetriya Gramin
Bank for a minimum period of two years from the date of joining the bank service,
has to execute an indemnity with surety in favour of Employer Bank.
NOW THIS INDENTURE WITNESSETH as under:
1. In compliance of the aforesaid condition in the Offer of Appointment subject to
which the Employer Bank has agreed to give appointment to the Selected
candidate, the Selected candidate hereby undertakes to serve the Employer
Bank for a minimum period of two years.
2. The Selected Candidate agrees and undertakes, to indemnify the Employer Bank
that in case he/she commits breach of the above condition and resigns from or
leaves/abandons the service and/or neglects in performance of the duty assigned
to him leading to termination of his/her service as per Rules and Regulations by
the Employer Bank for all losses, costs, charges and expenses upto extent of Rs.
_____________ and pay an amount of Rs. __________ (Rs.
____________________________) only with the interest thereon @ 12 per cent
per annum from the date of breach of the above till payment as liquidated
damages/cost of training including on the job training, the expenses which the
Bank has incurred/may have to incur in recruiting another Selected Candidate at
his/her place, and also on account of business loss suffered/to be suffered by
Employer Bank during intervening period.
3. The party of the second part i.e. Sh.____________________________ S/o
Sh.___________________ agrees to stand as Surety for the due performance of
the obligation of the Selected Candidate under this agreement of indemnity.
4. The party of the Second Part undertakes and declares that he/she is having
satisfactory and adequate means, and stands as Surety for the due performance
of the obligation by the Selected Candidate under his bond. In case of breach of
the terms of this indemnity by the Selected Candidate and failure to indemnify the
Bank, to pay the amount of Rs. 1,00,000/- (Rs. one lac only) together with
interest thereon @ 12% per annum from the date of breach to Employer Bank
immediately on demand. The Surety shall be jointly and severally liable to pay the
aforesaid amount to the Employer Bank.
Contd..3
(3)
Photo of Signature of
Candidate Name :_____________________
& Signature
across
WITNESS: WITNESS:
1. Signature ___________________ 2. Signature ___________________
Name : ____________________ Name : ____________________
Son/Daughter of : _______________ Son/Daughter of : _______________
Full Address ___________________ Full Address ___________________
______________________________ ______________________________
Mobile No. _________________ Mobile No. _________________
(To be submitted at the time of joining By Officer)
INDEMNITY BOND WITH SURETY
(To be stamped of Rs. 2000/- as per State Stamp Rules and Notarized)
This Indemnity is made and executed at ___________________ day of __________2017 by
Sh./Smt./Miss____________________________________________________________
Son/Daughter of Shri ___________________________________________________ a permanent
resident of _______________________________________________________
___________________________________________________________ hereinafter called
Selected candidate, the party of the First Part which expression shall unless repugnant to the
subject or context mean and include legal heirs, representatives and assigns, has been offered an
appointment for the post of Officer Junior Management Scale-I vide letter No. HO/2017-18/
HRM/.............. dated . . . . . . . . . . . by the Employer Bank, i.e. Baroda Rajasthan Kshetriya
Gramin Bank. AND
Shri ______________________________________S/o Shri ______________________ a
permanent resident of _______________________________________________________
________________________________________________________________ hereinafter called
Surety, the party of the Second Part which expression shall unless repugnant to the subject or
context mean and include legal heirs, representatives and assigns, have at the request of the First
Part stand as Surety to the Financial Bond extended by First Part (Selected candidate) in favour of
Baroda Rajasthan Kshetriya Gramin Bank, a body corporate constituted under the Regional
Rural Banks Act, 1976 (21 of 1976) Regional Rural Banks amendment Act,2015 and Gazette
Notification dated 01.01.2013 issued by the Government of India, Ministry of Finance, Department
of Economic Affairs (Banking Division) having its Head Office at Ajmer hereinafter called Employer
Bank which expression shall unless repugnant to the subject or context shall mean and include
their successors, executors and administrators.
Contd..2.
(2)
WHEREAS the Selected candidate has been selected for appointment as Officer Junior
Management Scale-I in the service of the Employer Bank.
WHEREAS an Offer of Appointment containing the terms and conditions of the appointment as
Officer Junior Management Scale-I has already been issued to the Selected candidate vide letter
No. HO/2017-18/HRM/......... dated . . . . . . . . .. of the Employer Bank.
WHEREAS the acceptance of the terms and conditions of the appointment has already been
communicated to the Employer Bank on dated ________________ by the Selected candidate.
WHEREAS one of the terms and conditions of the appointment is that the Selected
candidate has to serve the Employer Bank i.e. Baroda Rajasthan Kshetriya Gramin Bank for
a minimum period of two years from the date of joining the bank service, has to execute an
indemnity with surety in favour of Employer Bank.
5. Notwithstanding anything contained herein above, furnishing of this indemnity will not
create any right in favour of the Selected Candidate to continue in the service of
Employer Bank for the aforesaid term of two years, and the Employer Bank shall always
have the right to take appropriate action against the Selected candidate as per terms of
the appointment letter and/or the Rules and Regulations of the Employer Bank as
applicable, in case of commission of any misconduct by the Selected Candidate.
6. The amount specified above shall constitute a debt owing to the Employer Bank and
shall be recoverable from the Employee and the Surety jointly and severally with interest
thereon at the rate specified above till payment.
7. Apart from this indemnity, if the Selected candidate desire to leave the services of the
Bank, he will have to give one month notice under probation and after confirmation three
months notice to the Bank, failing which, Selected candidate shall be liable to pay to the
Employer Bank as compensation a sum equal to his pay for the period of notice required.
Signed and delivered by the Party of the First Part i.e. the Employee having perused and
understood the contents terms of this Agreement .
Signed and delivered by the Party of the Second Part i.e. the Surety having perused and
understood the contents/terms of the Agreement.
IN WITNESS whereof, the Selected Candidate and the Surety have put their signatures in the
presence of the witnesses.
Photo of Signature of
Candidate Name :_____________________
& Signature
across
WITNESS: WITNESS:
1. Signature ___________________ 2. Signature ___________________
Name : ____________________ Name : ____________________
Son/Daughter of : _______________ Son/Daughter of : _______________
Full Address ___________________ Full Address ___________________
______________________________ ______________________________
Mobile No. _________________ Mobile No. _________________
(To be submitted at the time of joining By Officer)
INDEMNITY BOND WITH SURETY
(To be stamped of Rs. 2000/- as per State Stamp Rules and Notarized)
This Indemnity is made and executed at ___________________ day of __________2017 by
Sh./Smt./Miss____________________________________________________________
Son/Daughter of Shri ___________________________________________________ a permanent
resident of _______________________________________________________
___________________________________________________________ hereinafter called
Selected candidate, the party of the First Part which expression shall unless repugnant to the
subject or context mean and include legal heirs, representatives and assigns, has been offered an
appointment for the post of Officer Middle Management Scale-II vide letter No. HO/2017-18/
HRM/.............. dated . . . . . . . . . . . by the Employer Bank, i.e. Baroda Rajasthan Kshetriya
Gramin Bank. AND
Shri ______________________________________S/o Shri ______________________ a
permanent resident of _______________________________________________________
________________________________________________________________ hereinafter called
Surety, the party of the Second Part which expression shall unless repugnant to the subject or
context mean and include legal heirs, representatives and assigns, have at the request of the First
Part stand as Surety to the Financial Bond extended by First Part (Selected candidate) in favour of
Baroda Rajasthan Kshetriya Gramin Bank, a body corporate constituted under the Regional
Rural Banks Act, 1976 (21 of 1976) Regional Rural Banks amendment Act,2015 and Gazette
Notification dated 01.01.2013 issued by the Government of India, Ministry of Finance, Department
of Economic Affairs (Banking Division) having its Head Office at Ajmer hereinafter called Employer
Bank which expression shall unless repugnant to the subject or context shall mean and include
their successors, executors and administrators.
Contd..2.
(2)
WHEREAS the Selected candidate has been selected for appointment as Officer Middle
Management Scale-II in the service of the Employer Bank.
WHEREAS an Offer of Appointment containing the terms and conditions of the appointment as
Officer Middle Management Scale-II has already been issued to the Selected candidate vide letter
No. HO/2017-18/HRM/......... dated . . . . . . . . .. of the Employer Bank.
WHEREAS the acceptance of the terms and conditions of the appointment has already been
communicated to the Employer Bank on dated ________________ by the Selected candidate.
WHEREAS one of the terms and conditions of the appointment is that the Selected
candidate has to serve the Employer Bank i.e. Baroda Rajasthan Kshetriya Gramin Bank for
a minimum period of two years from the date of joining the bank service, has to execute an
indemnity with surety in favour of Employer Bank.
5. Notwithstanding anything contained herein above, furnishing of this indemnity will not
create any right in favour of the Selected Candidate to continue in the service of
Employer Bank for the aforesaid term of two years, and the Employer Bank shall always
have the right to take appropriate action against the Selected candidate as per terms of
the appointment letter and/or the Rules and Regulations of the Employer Bank as
applicable, in case of commission of any misconduct by the Selected Candidate.
6. The amount specified above shall constitute a debt owing to the Employer Bank and
shall be recoverable from the Employee and the Surety jointly and severally with interest
thereon at the rate specified above till payment.
7. Apart from this indemnity, if the Selected candidate desire to leave the services of the
Bank, he will have to give one month notice under probation and after confirmation three
months notice to the Bank, failing which, Selected candidate shall be liable to pay to the
Employer Bank as compensation a sum equal to his pay for the period of notice required.
Signed and delivered by the Party of the First Part i.e. the Employee having perused and
understood the contents terms of this Agreement .
Signed and delivered by the Party of the Second Part i.e. the Surety having perused and
understood the contents/terms of the Agreement.
IN WITNESS whereof, the Selected Candidate and the Surety have put their signatures in the
presence of the witnesses.
Photo of Signature of
Candidate Name :_____________________
& Signature
across
WITNESS: WITNESS:
1. Signature ___________________ 2. Signature ___________________
Name : ____________________ Name : ____________________
Son/Daughter of : _______________ Son/Daughter of : _______________
Full Address ___________________ Full Address ___________________
______________________________ ______________________________
Mobile No. _________________ Mobile No. _________________
CHARACTER AND ANTECEDENTS VERIFICATION REPORT (APPLICATION FORM)
To
The Superintendent of Police,
District Police Office,__________
Subject : Application for Employee Verification
Sir,
It is requested that I have been selected as............................................in Baroda Rajasthan Kshetriya Gramin
Bank, a Bank constituted under the RRB Act, 1976 and having its Head Office at Plot No. 2343, IInd Floor,
Vaishali Nagar, Ajmer-305 004. The Bank requires that my character and antecedents may be verified and a
Police Verification Report may be issued to me. My personal particulars are as follow:-
1. Full Name (Expanded Initials) : .........................................................
Alias (if any) : .........................................................
2. Father (Full Name) : .........................................................
3. Spouse (Full Name), if married : .........................................................
4. Occupation: .........................................................
5. Nationality : ........................Age..............Sex..............Caste..............
6. Mobile No............................
7. Permanent Address:-
H.No. ............................Sector/Village/Locality............................
Police Station............................District........................................ Photo
State..........................................Pincode...................................... (Self signed)
8. Proof of Identity (Voter Card/Driving Licence/Ration Card etc.)
9. Local (Current Address) : .........................................................
.........................................................
.........................................................
Residing at current address since : ..........................................
10. Particulars of Previous Employment, If any
Nature of Employment .........................................................
Address : .............................................................................
..............................................................................
..............................................................................
Particulars of Previous Employer..........................................
11. Particulars of relatives residing locally (Current) Local Address
S.No. Name Father's Name Occupation Local Address
(1) ....................... .......................... ........................ .......................
(2) ....................... .......................... ........................ .......................
(3) ....................... .......................... ........................ .......................
(Signature of Applicant)
(For use of S.P. Office)
Name of the Applicant : ........................................................
Father/Husband's Name : ..................................................... Photo
Address : .............................................................................. (Self signed)
.............................................................................
..............................................................................
Report : .................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
igyh fu;qfDr ij ;k 31 ekpZ] --------------------- dks ;Fkkfo|eku vkfLr;ksa vkSj nkf;Roksa dh fooj.kh
Return of Assets and Liabilities on first appointment or as on the 31st March ..
yksdiky vkSj yksdk;qDr vf/kfu;e] 2013 dh /kkjk 44 ds v/khu
(Under Sec 44 of the Lokpal and Likayuktas Act, 2013)
*igyh fu;qDr dh n'kk esa] d`i;k fu;qfDr dh rkjh[k minf'kZr djsa % --------------------------------------
* (In case of first appointment please indicae date of appointment)
fVIi.k 1- bl fooj.kh esa ;k rks mlds Lo;a ds uke ;k fdlh vU; O;fDr ds uke yksd lsod dh lHkh vkfLr;ksa vkSj nkf;Roksa
dh fof'kf"V;ka varfoZ"V gksxhA fooj.kh esa yksdiky vkSj yksdk;qDr vf/kfu;e] 2013 dh /kkjk 44 2 esa ;Fkkmicaf/kr ifr ;k iRuh
vkSj vkfJr ckydksa dh vkfLr;ks@ a nkf;Roksa dh ckcr~ C;kSjs lfEefyr gksx
a sA
(/kkjk 442 yksd lsod ml rkjh[k ls ftldks og viuk inxzg.k djus ds fy, 'kiFk ysrk gS ;k izfrKku djrk gS] rhl fnu dh
vof/k ds Hkhrj l{ke izkf/kdkjh dks &&&&
d mu vkfLr;ksa ds lEcU/k esa ftudk og] mldk ifr ;k iRuh vkSj mlds vkfJr ckyd la;qDrr% ;k i`Fkdr% Lokeh ;k
Qk;nkxzkgh gS %
[k vius vkSj vius ifr ;k iRuh vkSj vius vkfJr ckydksa ds nkf;Roksa ds lEcU/k esa] lwpuk nsxkA
fVIi.k 2- ;fn dksbZ yksd lsod] ;k rks ^^drkZ^^ ;k fdlh lnL; ds :i esa dqVqac dh lEifRr;ksa esa lg leka'kh vf/kdkjksa ds lkFk
fgUnw vfoHkDr dqVqac dk lnL; gS rks mls ,sls lEifRr esa vius Hkkx dk ewY; izk:i la- 3 dh fooj.kh esa minf'kZr djuk pkfg,
vkSj tgka ,sls Hkkx dk Bhd ewY; minf'kZr djuk lEHko ugha gS] ogka bldk yxHkx ewY; minf'kZr gks] Li"Vhdj.k fVIif.k;ksa dks
tksM+k tk ldsxk] tgka dgha vko';drk gksA
fVIi.k 3- ^^vkfJr ckyd^^ ls ,sls iq= vkSj iqf=;ka vfHkizsr gSa ftuds ikl miktZu dk dksbZ i`Fkd lk/ku ugha gS vkSj os viuh
vkthfodk ds fy, iw.kZr% yksdlsod ij vkfJr gSaA uhps yksdiky vkSj yksdk;qDr vf/kfu;e 2013 dh /kkjk 443 dk Li"Vhdj.k
Note 3:-- "dependent children" means sons and dauthters who have no separate means of earning and are wholly dependent
on the public servant for their livelihood. (Explanation below Section 44 (3) of Lokpal and Lokayuktas Act 2013)
cM+kSnk jktLFkku {ks=h; xzkeh.k cSad
Baroda Rajasthan Kshetriya Gramin Bank
cSad vkWQ cM+kSnk }kjk izk;ksftr (Sponsored by Bank of Baroda)
2 ifr ;k iRuh
(spouse)
3 vkfJr&1
(dependent-1)
4 vkfJr&2
(Dependent-2)
5 vkfJr&3
(dependent-3)
6 vkfJr&4
(dependent-4)
*7 vkfJr&5
(dependent-5)
-2-
fdlh izn'kZ dh ckcr~ C;kSjs rHkh minf'kZr djsa ;fn ml fof'k"V izoxZ
vFkkZr~ QuhpZj] fQDlpj] bysDVkfud miLdj vkfn esa lfEefyr
fdlh fof'k"V vkfLr dk dqy orZeku ewY;] ;FkkfLFkfr] nks ekl ds ewy
osru ;k 1-00 yk[k :i, ls vf/kd gks
(Indicate the details of an asset, only if the total current value of any
particular assets in any particular category (e.g. furniture, fixtures,
electronic equipments, etc.) exceeds two months' basic pay of Rs. 1.00
lakh, as the case may be)
igyh fu;qfDr ij ;k 31 ekpZ --------------------------- dks ;Fkkfo|eku _.kksa vkSj vU; nkf;Roksa dk fooj.k
Statement of Debts and Other Liabilities on first appointment or as on 31st March ..
fVIi.k 1 % m/kkjksa dh O;f"Vd enksa dks tks nks ekl ds ewy osru ls vf/kd ugha gS tgka ykxw gkas vkSj vU; n'kkvksa
esa 1-00 yk[k :i;s gSa] lfEefyr fd;s tkus tkus dh vko';drk ugha gSA
Note 1: Individual items of loans not exceeding two months basic pay (where applicable) and Rs. 1.00 lakh in other cases
need not be included.
fVIi.k 2 % fooj.k esa cSadks]a dEifu;ka] foRrh; laLFkvksa] dsUnzh; ljdkj@jkT; ljdkj ls vkSj O;f"V;ksa ls fy, x,
fofHkUu _.kksa vkSj vfHknk;ksa ,Mokalksa dks lfEefyr djuk gksxkA
Note 2. The statement should include various loans and advances (exceeding the value in Note 1) taken from banks,
complaints, financial institutions, Central /State Government and from individuals.