wae eg we A ae aA ae A ATI 1a wrt va 4 aie ¢ wo savas wr SG sifted | 2.06 Une Use aa a wet wea wy] 3.01 WAT Ga wl Kamara ofa | 4.50 Ua (GO 50/- & KT ®) | 8.3 Part wart ua at eavenftre wie | 6.3 Ors Ot Cafes wa | 7. AMT Ua at Kafer vA | adm SR O eI YS of waite wa / . (rar) ale — war WAT Sede FETT wraTMAY Ft TTT Scanned with CamScannerRAJASTHAN STATE SPORTS COUNCIL SAWAI MANSINGH STADIUM JAIPUR VERIFICATION FORM Fill Single Form for AM Achievment {_] Sports Name / “| 1. Applicant's Detail Surname] Middle Name| First Name| 2. Father's Name = C 3. Gender Male Female 4, Date of Birth ] 5. Full Postal/Residential Address : 6, Mobile Number = go} 7. AIC Holder's : [ 8. Bank A/C No. = [ 9, Bank IFSC Code : 10. Achievement Details = International National State (Mention No, OF Compitition) 11. Age Category + Senior Junior Sb. Junior (enton No, OF Categories) 12, Medi Gold Silver Bronze (Mention No, OF Medsls) | Please Tick Below: 13. Attached Copy of the Certificate (Self Attested) Yes No [ ] 14, Attached Copy of the Adhar Card : Yes No 15, Attached Copy of theBank Passhook with IFSC COD| yes LL no [ Place: Date: Signature of Applicant Scanned with CamScannerwe Ta Fn FATA Foon SA... TH Prareit srw gin Gr see ER Rt weed foc @ fh aR eae wen RY arr FF ofthe Sua /uew & hes Gi A wor aver 3 arg yar él So ma 81 He. wearer ar rT ahora ‘felt we / ore waa wey AY gre yet ere gare 4 fear a @ feet weR B meat wt AR ETT fear a€i wren 8) aR ag wea Te OTT eM at A eT fry phere Geer ESAT fertie : sreerafgar Scanned with CamScanner