From January 2013
of birth according to (i) Age . years .. months
Madhyamik or equivalent examination certificate. (ii) Date of Birth ddmmyyyy: -
4. Gender: Please tick against the right box on
5. (a) If you belong to SC / ST / OBC provided in the right-hand side /OBC-A i SC, name of the Caste
/OBC-B of West Bengal, please mention the same in detail as provided in ii ST, name of the Tribe the right - hand side iii OBC/ OBC-A / OBC-B, name of the Caste .
(b) Designation of issuing authority of SC / ST / OBC / OBC-A/ OBC /
OBC-B Certificate; Certificate No. & Date please enclose self-attested copy
6. Do you like to be considered for a similar post of any other Co- operative Institution, against its current or future vacancy reporting, in
case you fail to get qualified for appointment in the Co-operative Yes → No→
Institution of your choice, but get qualified for some other Co-operative
Institution as per your rank in the comparative merit list?
7.(a) Application Fee paid Service charge payable to the Bank * Paid Application Fee for Rs.160.00 only vide
NOTE:-SC & ST candidates do not require to pay • Not paid any Application Fee as SC / ST
any Application Fee candidate
strike out whichever is not applicable
(b) Name the Bank where the Application Fee has been
deposited through Bank Challan / transmitted through NEFT
(c) Name of the Bank Branch of The West Bengal State Co-operative
Bank Ltd. through which Bank Challan is deposited.
(d) Unique Transfer Reference (UTR) No. in case of NEFT
8.1. All Academic