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Amount Rs
Date:
I p!
.
Affix recent
self attested
colour
photograph
(1)
(2)
Father's Name
(3)
Mother's Name
(4)
(5)
Gender
(6)
Female
:MaleD
Mobile
1\'0
E-mail
(7)
Category
(Tick Mark & Attach Certificate)
(8)
Education Qualification
:scD
ST
DOBCDGenD
S.No
Name of
Examination
Passed with
Branch (if
applicable)
Board/University
Year
Max/Obtained
Marks
Roll No.
I
I
Percentage
/Division
(9)
S.No.
Months
DII
Post
ration/period
From
4
(10)
(11)
To
Remarks
Day
.
:
') <,CLARATTON
I hereby solemnly declare that all the above
furnished
informationts:
awar
any attempt has been made by me to willfully conceal or misrepresent the facts, my candidature may be
rejected and my employment may be terrnin: .. I.
Place:
Date:
Signature of Candidate
Name:
I
ddrcss
Contact
No