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HARYANA POLICE GENERAL VERIFICATION SERVICES

¡ǐš™ȡŽȡ”Ǖͧ›  ȡ˜ȡۙ ×™ȡ”“ ȯȡ

CHARACTER VERIFICATION REQUEST



…ǐšğĤ˜ȡŽ”ğ\“ǕšȪ’
District
ǔ‡›ȡ NUH

Office Name
€ȡ™ȡ[›™€ȡ“ȡ˜ Superintendent of Police, Mewat

Appplicant Name
]ȯ‘€€ȡ“ȡ˜ SHUKAIN 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ͬ’ By Post

Purpose for Applying


`Ƨȯæ™ For Job

Relation Type 
 Ȳ–Ȳ’€ȡĤ€ȡš Father Gender
ͧ›Ȳ‚ Male

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

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

Relation Type 2
 Ȳ–Ȳ’€ȡĤ€ȡš Father Relative Name 2
ǐšæȯ‘ȡš€ȡ“ȡ˜ Navesh Ray
Challan No.( …ȡ›ȡ“ Ȳəȡ 
ID No.
”¡…ȡ“ Ȳəȡ 
Email ID
_˜ȯ› 

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)
]™Ǖ Year(s) 4 Month(s)
Present Address
[˜ȡ“”ȡ Street : GENERAL HOSPITAL District : NUH State : HARYANA P.S : CITY NUH PIN : 122107 Village /
Town / City : NUH MEWAT INDIA

Permanent Address
èȡ™Ȣ”ȡ Street : GENERAL HOSPITAL District : NUH State : HARYANA P.S : CITY NUH PIN : 122107
Village / Town / City : NUH MEWAT 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˜ Superintendent of Police, Mewat

Username :
Ĥ™Ȫȏȡ“ȡ˜ shukain12345@ 14/06/2022
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˜ Superintendent of Police, Mewat

Username :
Ĥ™Ȫȏȡ“ȡ˜ shukain12345@ 14/06/2022

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