APPLICATION FOR NON CREAMY LAYER CERTIFICATE

1. Name of Applicant :
2. Address :
Village /Ward Town / GP
Post Office Mo!a
"e#ene $ircle Police %tation
&. 'ate of (irt)
*. $aste +enclose caste certificate, :
-. Name of .at)er //s0and :
1. Name of Mot)er :
2. .inancial stats of Parent+s, / /s0and / Wife :
3arning %orce T4pe of Organi!ation
+Go#t./P#t.,
Profession /Trade /
(siness / Agricltre
etc..
Name of Organi!ation /
'epartment
'esignation / Post )eld
Mot)er
.at)er
/s0and
Court Fee Stamp of Rs. 2.00
Wife
3arning %orce 5ncome "emar6s
Gross Annal
%alar4 / Amont
5ncome from
ot)er sorce
Total
Mot)er
.at)er
/s0and
Wife
7. "ecent Passport %i!e P)otograp) :
8. Pa4 slip /salar4 $ertificate +if emplo4ed, :
19. "eport of $ircle Officer :
11. 5 certif4 t)at t)e a0o#e particlars are tre to t)e 0est of m4 6nowledge and 0elief and
t)at 5 do not 0elong to t)e $ream4 :a4er O($s and eligi0le to 0e considered for posts so
reser#ed. 5n t)e e#ent of an4 information 0eing fond false or incorrect or ineligi0ilit4 0eing
detected 0efore or after t)e selection. 5 nderstand t)at m4 candidatre / appointment is
lia0le to 0e cancelled and 5 s)all 0e lia0le to sc) frt)er action as ma4 0e pro#ided nder
t)e law.
Place : %ignatre of t)e Applicant
'ate :