HARYANA POLICE GENERAL VERIFICATION SERVICES

¡ǐš™ȡŽȡ”Ǖͧ›  ȡ˜ȡۙ ×™ȡ”“ ȯȡ

CHARACTER VERIFICATION REQUEST

…ǐšğĤ˜ȡŽ”ğ\“ǕšȪ’
District
ǔ‡›ȡGURUGRAM

Office Name
€ȡ™ȡ[›™€ȡ“ȡ˜Deputy Commissioner of Police, East Gurgaon

Appplicant Name
]ȯ‘€€ȡ“ȡ˜SAURAV KUMAR

Date(Ǒ‘“ȡȲ€

Request No.(\“ǕšȪ’ Ȳ

Request Status
\“ǕšȪ’€ȧǔèǓRegistered

UID/Adhar No
™Ǘ]_ŒȢ Mode of Receiving
f€ğ€š“ȯ€ȧͪͬ’Other

Purpose for Applying

`Ƨȯæ™I CARD RENEWAL

Relation Type 
 Ȳ–Ȳ’€ȡĤ€ȡšFather Gender
ͧ›Ȳ‚Male

Relative Name 1
ǐšæȯ‘ȡš€ȡ“ȡ˜KISMAT RAJ DUBEY Landline No.
›ɇŒ›ȡ^““Ȳ–š

ID Type
”¡…ȡ“€ȡĤ€ȡšAadhar Card Mobile No.
˜Ȫ–ȡ^›

Relation Type 2
 Ȳ–Ȳ’€ȡĤ€ȡšMother Relative Name 2
ǐšæȯ‘ȡš€ȡ“ȡ˜ASHA DEVI
Challan No.( …ȡ›ȡ“ Ȳəȡ
ID No.
”¡…ȡ“ Ȳəȡ
Email ID
_˜ȯ›ER.SAURAVDUBEY@GMAIL.COM

Passport Issue Place

”ȡ ”ȪŠ[‡ȡšȣ¡Ȫ“ȯ€ȡèȡ“ Passport Issue Date
”ȡ ”ȪŠ[‡ȡšȣǓͬ

Date of Birth (DD/MM/YYYY)

‡Û˜Ǔͬ Age (Years/Months)
]™ǕYear(s) 11 Month(s)
Present Address
[˜ȡ“”ȡH.No : C/O SANDEEP Street : GALI NO 3, NEAR SATGURU PG Colony : SATGURU ENCLAVE District :
GURUGRAM State : HARYANA P.S : PALAM VIHAR PIN : 122015 TEHSIL : PALAM VIHAR VILLAGE : NOBLE ENCLAVE EXTN INDIA

Permanent Address
èȡ™Ȣ”ȡStreet : BESIDE NH-2,NEAR ST THOMAS HIG Colony : SAHUBAHIYAR District : DHANBAD State :
JHARKHAND P.S : TOPCHANCHI PIN : 828402 TEHSIL : PS TOPCHANCHI VILLAGE : SAHUBAHIYAR INDIA

Is there any criminal records against you or your family?

șȡ]”€ȡ™ȡ]”€ȯ”ǐšȡš€ȯͨ›ȡ•€Ȫ_]”šȡͬ’€€ȡ™[ȡ¡ȣ
¡Ȱ!No

If Yes, Provide Details

™Ǒ‘¡ȡȱͪšŽĤ‘ȡ“€šɅ

Office Name
€ȡ™ȡ[›™€ȡ“ȡ˜Deputy Commissioner of Police, East Gurgaon

Username :
Ĥ™Ȫȏȡ“ȡ˜1234@sau 16/12/2019
 HARYANA POLICE GENERAL VERIFICATION SERVICES

¡ǐš™ȡŽȡ”Ǖͧ›  ȡ˜ȡۙ ×™ȡ”“ ȯȡ

CHARACTER VERIFICATION REQUEST

…ǐšğĤ˜ȡŽ”ğ\“ǕšȪ’
All the information provided in the form is true?
a”š‘ȣ‚_ —Ȣ‡ȡ“€ȡšȣ ¡ȣ¡Ȱ!Yes

Office Name
€ȡ™ȡ[›™€ȡ“ȡ˜Deputy Commissioner of Police, East Gurgaon

Username :
Ĥ™Ȫȏȡ“ȡ˜1234@sau 16/12/2019