00: ,

DATE:
/PLEASEENTERALLDETAILSINBLOCKLETTERS

( )/

HRMSPROFORMA(Nocolumnshouldbeleftblank)

/Nameofthecandidate
/FathersName

/Address(Permanent)

/AddressforCorrespondence

: /Distt:State:

: /Distt:State:

JoinedPNBas:
:( /. /. /)

/PhoneNos:

Category:(Gen/SC/ST/OBC)
-/EMail

/HomeTown

:( /

MartialStatus:(Single/Married)
/DateofBirth

/DateofMarriage

/Domicile

/PlaceofBirth

/MotherTongue

/IdentificationMark

0/PANNo.*

/Religion

/BloodType

Educational
Qualification

Stream/Subjects

/
/Dateof %ageofMarks Board/University

Passing

 /ProfessionalQualification

( ,)/

HealthProblem(ifany)
/LanguagesKnown

/Hindi

/English /Other_____

/Speak

/Write

/Read

( )/

Disability(ifany)
/Handicap%

/Evaluationdate

0/ /CardNo/Date

/CardIssuingAuthority

/DependantInformation:

(1)/Name

/Relation

/Address

(2)/Name

/Relation

/Address

(3)/Name

/Relation

/Address

(4)/Name

/Relation

Address

/EmergencyContact:

/Name

/Address

0/PhoneNos.

( /Signatureofcandidate)

The particulars in the

aboveproformahavebeenverifiedfromtheoriginal.

/SignatureofCheckingOfficial)
(