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FORM OF VERIFICATION ROLL

Responsible officer should properly interrogate the applicant for correct

entries all the items, because any omission is likely to cause delay and had to
confusion indentify.
It should be clearly in the report of the inquiry office that the candidate is
identity has been established beyond doubt.
1. Name in full will aliases, if any __________________________________
2. Father's name in full with aliases if __________________________________
any and designation of service if any

3. Nationality of
a) Father __________________________________
b) Mother __________________________________
c) Husband __________________________________
d) Wife __________________________________

4. Place of birth of
a) Husband __________________________________
b) Wife __________________________________

5. Home address in full __________________________________

(i.e. Village, Thana, Distt., Road, Street or
house no. etc.)

6. if originally a resident of Pakistan, the __________________________________

address in that nominion and the date of
migration of India union should be
stated here.
7. Permanent address in full : __________________________________
__________________________________
__________________________________

8. Address during the preceding 5 years __________________________________

__________________________________
__________________________________

9. a) Date of birth __________________________________

b) Present age __________________________________
c) Age at matriculation (if matriculate) __________________________________
 10. Education Qualification showing places __________________________________
of education with years in __________________________________
schools/colleges since 5 years of age
11. Officers or firms with full description and __________________________________
address where the candidate worked
12. Name of two responsible persons in __________________________________
locality or two reference to whom the
candidate is known

13. Signature and designation of the issuing __________________________________

officer with full address and date

14. Has the candidate ever been convicted __________________________________

by a court if any offence? If the answer is
Yes the full particulars should be given

(Certificate to be signed by the candidate)

Certificate that the forgoing information is correct and complete to the best
of my knowledge and belief. I am not aware of any circumstances which might
impair my fitness for employment under Government.

Place
Date (Signature of Candidate)

Place (Signature & designation

Date of the officer initiating
the verification roll)

(The name of the officer

with full particulars and
date should also be given)
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