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DOMESTIC SERVANT/EMPLOYEE VERIFICATION FORM

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1. Name 'of the

2. Father's Name
3. Mother's Name
Photograph of
4. place &: Date of Servant/Emplo
yee
5. Language spoken

6. Permanent Address

PO Dist.lict

Country
,:f

7. DQ;taiIs of id~mtificati(}n:rr9'oQik~Ration Carc1ro'chrimg License f

Learn, jf any ",;;';'"';[f(;;~;}H;[i~'-''''' ,

8.

9" Local.Address

,"
 FOR POLICE USE ONLY
l'ART- HI

·i. Form Prep arod by

Naxne r Rank
Range No. PIS No.

Pol.ice Station District

:2. Result ofveri:f'i.cation from eRO

3. Result of verification from Firiq er' Print Bureau

4.

5. Result of verification from. previous employers

6.

7. Result of verification from the concerned Police Station

(oF Delhi to be done Iocal PS) . .

8. Details of verification form sent to DCP office for enquiry from SHO Home
TOVJn

PS District State

Despa.tch No. Date

S.H.O

9: .Result of verification from home town /Dato & d ei:ca.ils of verification received
from home town' .

S.H.O

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ACKNOWLEGEMENT

Received Servant/Employee verification form from Sh.!Smt.

-in favour of Sh./SmL on

Signature of Duty officer

PS
 r-=y
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PART'H-B

RiGHT RAAr:DIMPHESSION OF THE SERVkW/EMPLOYEE

Plain prints of four fingerS & thumbs taken simultaneously

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(Vohm,tzi.dlygi:v.;D to the employer)
(To be fined up by Employe. only)
Signature of em,ployee

Signature of employer-