Character Certificate Request (Modification)

…ǐšğĤ˜ȡŽ”ğ\“ǕšȪ’
 ȲžȪ’“

Character Certificate Request No.

…ǐšğĤ˜ȡŽ”ğ\“ǕšȪ’ Ȳ District
ǔ‡›ȡ

Police Station
ȡ“ȡ Date
Ǒ‘“ȡȲ€

1) Character Certificate Details

…ǐšğĤ˜ȡŽ”ğͪšŽ

a) Name
“ȡ˜KantiBudakoti b) UID
™Ǘ]_ŒȢ

c) Father's Name
ͪ”ȡ€ȡ“ȡ˜Devendra Prasad d) Gender
ͧ›Ȳ‚”ǕǽŸ

e) Date of Birth
‡Û˜Ǒ‘“ȡȲ€ f) Age
]™ǕŸɟ

g) Address
”ȡ

S. No.
Đ Ȳ Address Type
”ȡ€ȡĤ€ȡš Address
”ȡ Duration of stay
š¡“ȯ€ȧ
\ͬ’
1 [˜ȡ“”ȡ 67,Block F,Sector 20,Noida,“ȫfŒȡ ȰȊš€ͧ˜æ“šȯŠ‚ȫ˜–Ǖƨ“‚š`׏š Ÿ[˜ȡ¡
Ĥ‘ȯž—ȡš
2 èȡ™Ȣ”ȡ 67,Block F,Sector 20,Noida,“ȫfŒȡ ȰȊš€ͧ˜æ“šȯŠ‚ȫ˜–Ǖƨ“‚š`׏š Ÿ[˜ȡ¡
Ĥ‘ȯž—ȡš

h) Email Id
_˜ȯ›]_ŒȢbudakotipawan@gmail.com i) Mode of Receiving
Ĥȡ܏€š“ȯ€ȧͪͬ’

j) Purpose for Applying this Service

™¡ ȯȡ›ȡ‚Ǘ€š“ȯ€ȯͧ›f`Ƨȯæ™

k) Landline No.
›ɇŒ›ȡ^“ Ȳ

l) ID Type
”¡…ȡ“Ĥ€ȡš

m) ID Number
”¡…ȡ“ Ȳ

n) Mobile No.
˜Ȫ–ȡ^› Ȳ

o) Scanned Photo
è€Ȱ“ͩ€™ȡ¡Ǖ]ͬ…ğ

2) Affidavit
ž””ğ

a) Do you have any criminal record or any criminal proceeding against you or your family in any part of the country? If Yes, Provide details
șȡ]”™ȡ
]”€ȯ”ǐšȡš€ȯͨ›ȡ•‘ȯž€ȯͩ€ Ȣ—Ȣ—ȡ‚˜Ʌ]”šȡͬ’€ǐš€ȨŒ[™ȡ€Ȫ_]”šȡͬ’€€ȡ™[ȡ¡ȣ¡Ȱ!™Ǒ‘¡ȡȱͪšŽ‘ȯ“¡ȣȲ

b) All the information provided above is true

a”š‘ȣ‚_ —Ȣ‡ȡ“€ȡšȣ ¡ȣ¡Ȱ¡ȡȲ

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Report Printed on
ǐš”ȪŠ[˜ǕġŽ€ȧǑ‘“ȡȲ€ Signature
¡èȡ¢š

Report Printed by
ǔ‡ €ȯɮȡšȡǐš”ȪŠ[˜ǕǑġ Name
“ȡ˜Kanti Budakoti

Rank
”‘

No.
 Ȳ

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