DETAILS OF TWO REFEREES

I have been selected for the post of ______________________ (Roll No. ______________).
I submit the details of TWO referees, who are not my relatives and my present address for
communication as under: -

1) Name of Referee _________________________________________

Address _________________________________________
_________________________________________
_________________________________________
_________________________________________
Telephone _________________________________________
Mobile No. _________________________________________
Fax No. _________________________________________
Email ID _________________________________________

2) Name of Referee _________________________________________

Address _________________________________________
_________________________________________
_________________________________________
_________________________________________
Telephone _________________________________________
Mobile No. _________________________________________
Fax No. _________________________________________
Email ID _________________________________________

Name of Candidate _________________________________________

Present Address _________________________________________
for communication _________________________________________
_________________________________________
Telephone _________________________________________
Mobile No. _________________________________________
Fax No. _________________________________________
Email ID _________________________________________

Date : __________
Place : __________
_______________________
(Signature of Candidate)