Appendix A;ll'
sTTi{T q-T APPLICATION FORM
( we qffit t {rqT clrq gE w d <H ow erri \'4 ffi e d )
arafi a1 qrsqrd silqrs
() a1 <-wrqrfud q.tdt
Recent passport size
3Tl-ifi tf{/Name of the post applied forl self-attested photo
# fusrqq scqr liurtta *flq* tffi-6
Ref : Advertisement No. of Employment News dated
Name of the Applicant (in Block Letters)
/qlil 6r rrq
Father's/Husband's Name
(b) qrat ibl ?rrrT
Mother's Name
Address for correspondence
ITdEIFT IIIITUFT=I iD-I q?Drt VtT WgT
Proof of ldentity (AadhariPANA/oter lD)
Age as on closing date Yrs months _ days
(c) cr{ 4 g /;TT Yes/No
Age relaxation claimed, if any
( qfr 6T dt 4"ft or vdq of )
allv mention name of
Name of Employment Exchange where
Employment Exchange Registration No.
/;il Yes/No
cnq fre'sr Ef ,reuPfo w d orqh
E f/fd dq o-fl Q qeE-d d (qR ar ot iofr lcategory
d"ft)
Whether belongs to SC/ST/OBC/EWS/ Ex-
Serviceman (if ves, mention the
Sex (Male I Female
Educational Qualifi cation
iFc
q- Educational Qualification
SI,
No.
Ctass tO siandards
iD-E diF I lT{rrrrrIdI
iDT
To lName&address
1A (a)Pol
(b) Proof of DOB
Certificates Enclosed (Tick relevant)
(c) Caste/Category Certificate
(d) Education qualifications (one/Two/rhree)
(e) Work Experience Certificate
17 ffiffi qr+ort qR Et lDetails of any other
information
(
STC"TT DECLARATION
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q6f-'1fF;1 | | do hereby declare that the particulars furnished above by me are correct to the best of
my knowledge and beliei. In the event of any infonnation being found to be incorrect at a later date,
my candidature / appointment may be cancelled / terminated without any notice-
ETq are-i d q'W 6r Pnsrn (SFs srri<-6i. d fuc)
of male and
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n of female candidate
*gTFT i Place
it-r gtllqrt
srico
(Signature of APP|icant)
frfq-i Datg . r :
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ffi rFor oiiicial
Aooendix A-"lll'
q-t$ qr 'qoMlr cARo
(ql sfrql d tn audicate) re-E,L@*w
std-@-@s
1) Recent passport size
photo self-aftested
Application No:
tr-
(orckq + sqql'r *q official use only)
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Name of the post applied for (in Bold letters)
# fuilq-{ qqr q}-qtnE vlttqF[ ffifr
Ref :Advertisement No. of Employrnent News dated
1. €rrt<a' or crqfw cmt {)
Name of the Applicant
(in full & Block Letters)
ftdf/cfr iDl ;nr1
Father's / Husband's Name
2
{ *a qat
EmaillD
4. fukoZetn"r qfiar or ftm-o
otq srq(orqlcq d eqqf.r tg)
Date & Time of Written Test / Tying
test (for official use onty)
fufua7eo.w qfiar ot rrar
(orqf.cq d srd'r fd
Venue of Written Test / Typing Test
(for official use only)
enqre-ordf< +dr{d rfqr
Emergency Mobile Number
sit Frer d cr{d 6l ft{rn (gFs 3rrt{6t' d faq)
Left thumb impression of mde
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fuq)
Right thumb impression in case of female candidate
s[rn{o' in-t rfintrt (Signature of Candidate)
fs: Note
r. rrra-<c c-i$ rt of sl cfr srtmt Am, frvtqs r. 2, 3 Vd e rfrFal' oi qtan qqr d qri I
Admit card should be submitted in dudlcate duly filled in sl, '1, 2, 3 & 6 by the apflicant.
