APPLICATION CUM PERSONAL DATA FORM

Name of the Candidate

1 (in Block Letters, as appearing in the GOKUL D
matriculation or equivalent certificate)

2 Sex Male

Date of Birth in DD/MM/YYYY

3 08/04/2002
(as per matriculation / equivalent certificate)

4 Age 21

Mobile Number: 7010021338

Email ID of the candidate: [email protected]

5
Alternate E-mail ID: [email protected]

Alternate Mobile Number: 8667686800

50/23
Munsiff street
6 Address for Correspondence with Pin code salem ,
Tamil Nadu ,
Pin: 636006

50/23
Munsiff street
7 Permanent Address with Pin code salem
Tamil Nadu
636006

India
8 Place of Domicile with District & State
Tamil Nadu

9 Nationality Indian

10 Religion Hindu

Vaniyar
11 Caste
OBC

NO
Do you belong to Scheduled Caste/ Tribe
12
(furnish Yes or No)
OBC

13 University Roll Number (Post Graduation) 20UCS4837

Have you studied Plus Two? Yes

14
Have you studied Diploma? No

Academic Qualifications: -Minimum aggregate percentage prescribed for the examinations is not allowed to be
15 rounded off. (For example: a candidate who secured aggregate of 59.99% or grade point equivalence will not be
permitted to appear for the selection process as the minimum stipulated aggregate is 60%).

The aggregate percentage obtained by the candidate would be ascertained based on the practice followed by the Board / University / Institution. In
case of the candidates being awarded Grades / CGPA or any other system, percentage would be based on the equivalence certified by the Board /
University / Institution

Academic Qualifications

Name of the Date, Month & Year

Course(eg: Main Subjects / of passing (as per % of
Institution Name of the School / College & University / Board
MBA,M.Com,M.Sc Streams mark sheet / marks
etc) certificate attached)

STATE BOARD JAYARANI MATRIC HR SEC SCHOOL SALEM 23-05-2018 87

STATE BOARD JAYARANI MATRIC HR SEC SCHOOL SALEM MATHS COMPUTER 16-07-2020 73
SCIENCE

PERIYAR COMPUTER
SONA COLLEGE OF ARTS AND SCIENCE B Sc 30-05-2023 70
UNIVERSITY SCIENCE

16 Details of the computer course, if any under gone? NA

17 Particulars of Post Qualification work experience (If applicable)

Period of service
Length of Reason for Last drawn
Name of employer & nature of duties performed Designation service in leaving monthly
From To
months service salary
(dd/mm/yy) (dd/mm/yy)

NA NA NA NA NA NA NA

18 Qualifying Course -

19 What are your extracurricular activities? DANCE

Have you received any prize/distinction or

20 INTERSCHOOL GROUP DANCE
scholarship?

Have you ever been discharged from a

21 No
position (Yes or No)

TAMIL Read Write Speak

ENGLISH Read Write Speak

22 Languages known

Have you or your family members had any

23 major illness, operation or accident? If yes, No
give details

No (Percentage : NA)

Scribe Name NA

Address of the Scribe NA

Do you have any physical/sensory/standing
24
disability/infirmity? If Yes, details.

Details of period during which candidate was

25 NA
neither employed nor studying

26 Blood Group A+

Have you or any of your close relatives, ever

27 been convicted of an offence? If yes, state No
details
 Father's / Guardian's name DAYANIDHI T

Father's / Guardian's Phone Number 8667686800

Employment Type Not Employed

Name of the Employer NA

Last Designation NA

28 Father's / Guardian's Annual Income NA

Name of Mother CHITRA D

Employment Type Employed

Name of the Employer CHITRA

Last Designation DEPARTMENT STORE

Mothers’s Income 120000

Not Married

Name of spouse NA

Employment details NA
If married, name of your spouse with their
29
employment details & annual income Annual Income NA

Number of children NA

30 How many brothers and sisters do you have? 1.0

Are your brothers or sisters employed? If yes,

31 Relationship / Age Employment
state their age and present employment?

Whether any of your family members are

32 suffering from any major illness? If yes, give No
details

Do you had / have any relative in the service

33 No
of Federal Bank? If yes

No

Are you related to any Directors of Federal

34 Name of the Director NA
Bank?

Relationship NA

Have you applied earlier for any post in

35 No
Federal Bank? if yes, give details

Why do you consider yourself suitable for this

36 program? Please emphasize what you hold to no
be notable achievements in the past.

Nearest City 1 Bangalore

37
Nearest City 2 Chennai
 Name, address (preferably residence address) and telephone number of three references excluding relatives and friends. If you have prior work
experience, one reference has to be from the last organization or employer.

Sl no Name of the person Full communication address Contact no and e-mail ID

50/23, gugai
1 SATHISHKUMAR salem, Tamil Nadu 9442816088,
636006
38

50/23, GUGAI
2 PARTHIBAN S Tamil Nadu, Tamil Nadu 9443275989,
636006

50/23, GUGAI
3 KARTHIKEYAN salem, Tamil Nadu 9443747099,
636006

DECLARATION BY CANDIDATE

I, GOKUL D hereby declare that I have gone through the eligibility criteria of Federal Integrated Program and other norms stipulated by the Bank
and agree to abide by the said stipulations. I also certify that the particulars furnised above are true to the best of my knowledge and belief. I
understand that if, at any stage I am found not eligible or the declaration given is found to be false/incorrect my candidature is liable to be cancelled
at any stage, without notice and conpensation.

I further declare and submit that,

1) I hereby confirm that the following Email id: [email protected] and the phone number: 7010021338 are valid and belong to me.

2) I understand that an application once submitted will not be allowed to be withdrawn and the application fee once paid will NOT BE refunded
under any circumstances nor would it be held in reserve for any future Online Aptitude Assessment or selection process. The application fee shall
also NOT BE refunded in case the application is rejected / not considered by Federal Bank.

3) I authorize the Federal Bank or any agency engaged by or acting on behalf of the Bank to carry out background verification of my educational
history, employment history, reference checks, criminal records, domiciliary details, social media activities, credit history including CIBIL / Experian
Scores and Status etc. I also understand that, in case of any adverse Background Verification Report or Credit History Report, the offer for Federal
Integrated Program / appoointment shall be withdrawn / cancelled.

Note: Candidates selected for the program shall be deployed in any of the Branches/Offices of the Bank depending upon the administrative
requirements of the Bank as part of the Federal Integrated Program.

As part of the screening process, you are required to scan and upload your signature as per specification ( png ,jpg ,jpeg format and the file size not more than 2 MB) in the portal. The scanned
signature uploaded by you shall be affixed on various forms, letters and declarations (including, but not limited to, Personal Data Form, Declaration to be submitted in the event of non-production of
original certificates at the time of document verification, Background Verification Consent Form and Federal Integrated Program Letter etc.) which are agreed/accepted by you through the portal and
such forms, letters and declarations shall be deemed to have been signed by you.

Date: 2023-04-26 Name of the applicant : GOKUL D