APPLICATION NO : CCLA-1337009

GOVERNMENT OF ANDHRA PRADESH Chief Commissioner Of Land Administration (CCLA)

APPLICATION FOR THE POST OF VILLAGE REVENUE OFFICERS Circular No.2, Dated 30.11.2011 1. 2. 3. 4. 5. 6. 7. 8. 9. Reference Id : 301210103707109031988
Name : SHAHEENABEGUM SHEIK District : NALGONDA Mandal : MOTHKUR Village : SADARSHAPUR Father's/Husband`s name : NAJIRODDIN Date of birth : 9/3/1988 Gender : Female Address for communication : 1-2-14 SADARSHAPUR MOTHKUR NALGONDA

9a. 9b. 9c. 10. 11. 12. 13. 14. 15.

District : NALGONDA Mandal : MOTHKUR Pincode : 508277 Community you belong : BC-B e-Mail : sheikshaheen.msc@gmail.com Mobile : 9000793217 Do you belong to Andhra Pradesh State : Yes Are you an Ex-Service Man : No Are you a PH-Person : No
*301210103707109031988*

PH Details
Visually Handicapped : Visually Handicapped Percentage : Hearing Handicapped : Hearing Handicapped Percentage : Orthopedically Handicapped : Orthopedically Handicapped Percentage : No 0% No 0% No 0%

16. 17. 17a.

Fee Amount
200

Post Name : VILLAGE REVENUE OFFICERS Qualification Details

Qualification : Intermediate or Equivalent Qualification

Payment Details
Journal Number
ESBZ04431788

Payment Date
26/12/2011

I hereby declare that all information furnished by me in this application is true and correct I undertake to produce the original documents at any moment, failing which my candidature may be cancelled. I am fully aware that furnishing false information will lead to a criminal case against me, apart from cancelling my candidature as it amounts to cheating. I am aloneresponsible if any wrong entries are made by me in the application form.

Sd/SHAHEENABEGUM SHEIK Generated for CCLA'S Recruitment Processing: http://ccla.cgg.gov.in/ POWERED BY Governance Centre for Good