REGD. NO D. L.-33004/99

The Gazette of India

EXTRAORDINARY

PART III—Section 4

PUBLISHED BY AUTHORITY

No. 184 ]

NEW DELHI, WEDNESDAY, SEPTEMBER 11, 2002/BHADRA 20, 1924

CHITRADURGA GRAMIN BANK

NOTIFICATION

Chitradurga, the 24th August. 2002

No. CGB/HO/PMS/HO/STF/3898/2002

SCHEDULE—III

(FORM B)

DECLARATION OF DOMICILE

[Sec Regulation 70]

Place

Date

* I, the undersigned, having been appointed in

the service of the Chitradurga Gramin Bank hereby

declare

(Place)in

(District)

as my place of domicile.

2. * The above is my place of birth.

Or

* The above is not my place of birth. My place of

birth is

(Place)m

(District)

but

(Place) has been declared as my

place of domicile for the reasons given below

Name in Full

Designation and Nature of

Appointment

Date of Appointment

:

Signature

:

* Strike out whichever is not applicable.

N. NARASA REDDY, Chairman

[ No. ADVT./III/lV/92-D/2002/Exty.]

2861

GI/2002

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