11/7/2019 APGSAVM 2019

ACCEPTANCE FORM
Date:
Place:

To,
The District Collector,
KURNOOL District.

Sir,
I hereby submit my acceptance for the post of Mahila Police and Women & Child
Welfare Assistant / Ward Women & Weaker Sections Protection Secretary (Female) Which I
have been offered vide Rc.No.11580/A12/VS/2019/DSC-2019/ ,Dated: /2019 issued
by the District Selection Committee/District Collector District.
I hereby accept unconditionally, all the terms and conditions stated in the Appointment
Letter issued vide Rc.No.11580/A12/VS/2019/DSC-2019/ ,Dated: /2019 issued by
the District Selection Committee /District Collector District.
I undertake that, I shall comply with all the terms and conditions relating to my
appointment and state that I would serve to the best of my knowledge and ability.
I undertake that, I shall be liable for any action that may be initiated against me, if any
information or certificates furnished by me is found to be false or incorrect or is misleading
either in the antecedent verification form or otherwise, which are submitted for the purpose
of securing my employment.

SIGNATURE
(MEDIPALLI GAYATHRI)
Address :
Name :MEDIPALLI GAYATHRI ,
S/o / W/O / D/o :MEDIPALLI GOPAL ,
4/196,GANESH CIRCLE,
ADONI,URBAN Adoni,
KURNOOL,518301
Mobile No : 7730912468
Hall Ticket No:191301086089

https://apgsvam197573reports.apcfss.in/ApGS19AcceptAppointmentLetter270919416.apgs 1/1