Application No: W0100096270 Application Form Anganwadi Worker

DEPARTMENT OF WOMEN & CHILD DEVELOPMENT AND SOCIAL WELFARE

MURSHIDABAD DISTRICT

Application Form for Direct Engagement to the Post of Anganwadi Worker.

Post and Residential Details:

Post applied for : Anganwadi Worker

Project Name : Beldanga-I ICDS Project
Notification No. : 320/ICD/BEL-I
Notification Date : 06/12/2022
Application Form Submitted On : 2022-12-30 17:32:42 from IP 42.105.192.172

Personal Details:

Applicant's Name * : Mst Mahafuza Khatun

Gender* : Female
Date of Birth* : 22/09/2000
Age : 21Years
Father's Name* : Masidur Rahaman
Mother's Name* : Bilkis Begum
Husband's Nme* : Baban Rahaman
Email ID* : mahafuza742133@gmail.com
Mobile No* : 7865086670
Nationality* : Indian Marital Status* : Married

Permanent Address as per the Voter Card (EPIC)/ Electoral Roll or in absence of electoral data, as per certificate of appropriate
authority

Address : Vill+po-Begunbari ps-Beldanga Dist -Murshidabad

Village/Ward : Begunbari
Block/Municipality : Beldanga-l
Sub Division : Berhampore Sadar Post Office: : Begunbari
Police Station : Beldanga Police Station District : Murshidabad
State : West Bengal Pin : 742133

Present Address:

Address : Vill+po-Begunbari ps-Beldanga Dist -Murshidabad

Village/Ward : Begunbari
Block/Municipality : Beldanga-l
Sub Division : Berhampore Sadar Post Office : Begunbari
Police Station : Beldanga Police Station District : Murshidabad
State : West Bengal Pin : 742133

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Photo Identity Proof (Voter Card (EPIC)/ Authority of Certificate Issued): :

Voter Card No (EPIC No) : RJG1986066

Category Details:

Category : OBC-A Whether belongs to Exempted Category(EC)? : No

Certificate Number : E7430 Date of Issuance : 14/07/2014
Issuing District : Murshidabad

Disablity Details:

Whether Person with Disability

: No
(40% and above)?

Educational Qualification Details ( Madhyamik or Equivalent ):

Year of Passing : 2017 Name of the State where this Board is situated : West Bengal
Name of the Recognised Board
W.B.B.M.E

Highest Educational Qualification Details:

Qualification : Higher secondary Year of Passing : 2019

Name of the Board / Organization
W.B.C.H.S.E

Declaration:

I have studied the advertising notice thoroughly. I have also gone through the requirements for the post. I do hereby
declare that all statements made in this application are true, complete and correct to the best of my knowledge. In the
event of any information being found false or incorrect or ineligibility being detected before or after or during any stage of
selection process, appropriate action will be taken against me.

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