POLICE STATION REGD.NO.

n7 Date: | 12017

PROFORMA FOR SERVANTS/ EMPLOYEE EMPLOYMENT

1. FULLNAME OF THE SERVANT/EMPLOYEE.

2. FATHER/ HUSBAND NAME......

3. AGE,.. .....RELIGION......

4. PRESENT ADDRESS IN GOA : ClO. ....PHONE NO"""

H.NO.......... WARDNO.......VILLAGE... .....P.O...

TALUKA................DISTRICT... ...STATE... POLICE STATION

5. NATIVE ADDRESS:

7. DATE OF EMPLOYMENT WITH PRESENT EMPLOYEE

8. HABITS..

9. NAME AND ADDRESS OF THE EMPLOYER... I

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10. ASSOCIATES.........

I I. IDENTIFICATION MARKS...

12. LANGUAGES SPOKEN...

I3. DRESSING PATTERN......

I4. WHETHER EMPLOYED PREVIOUSLY ELSEWHERE, IF SO GIVEDETAILS...

I5. REFERENCE OF TWO KNOWN PERSONS FROM THE NATIVE PLACE OF THE
SERVANT TO BE CONTACTED IN EMERGENCY.

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FILLING OF THIS PROFORMA IS PURELY VOLUNTARY AND DOES NOT BEAR ANY LEGAL ACCRODATION
VERIFICATION OF HIS CzuMINAL BACKGROUND
SAID PERSON. THIS INFORMATION IS FOR THE PURPOSE OF
AND TO PRESERVE RECORDS OF STRANGERS

*RESIDENTIAL PROOF OF NATIVE TO BE ATTACHED.

(SIGNATURE OF SERVANT /EMPLOYEE) (SIGNATURE OF THE EMPLOYER).