Application Cum / Personal Particulars Form for

Character Verification

1) Name in Full (in Block Letters): 2) Present Address in Full: 3) Duration at Present Address: 4) Jurisdiction of Police Station: 5) Home address in Full: 6) Jurisdiction of Police Station: 7) Applicant’s Date of Birth: 8) Place of Birth: 9) Present Age: 10) Particulars of Places (with period of residence): From To

Where you have resident during recent years since birth 1) 2) 11) Information

Father Mother Husband/Wife

Occupation Address


Present Address

Brother .

15) Present Occupation / Service with all particulars 16) Purpose for requiring this Character / Antecedence Verification Certificate (To whom it is required) 17) Identification Mark (Visible) 18) Name & Addresses of two prominent persons in your locality who know you 1) 2) 19) I here by solemnly state that.Sister Any Other Friends 12) Applicant’s Education Qualification: Name & Address of School & College Date of Joining Date of Leaving Examination 13) How ever been arrested /Prosecuted / detailed If so give particulars of Case. the information provided by me is true. 14) Have you ever active taken in politics if so Give Particulars. Signature of Applicant .


Xerox copy of the Passport/ Driving License / Election Card. Xerox copy of the School Leaving Certificate.Note: Applicants to attach the following documents with this application. . 1) 2) 3) 4) Two Passport Size Photographs. Xerox copy of Ration cards showing applicants Name and Address.

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