FORM FOR NOMINATION
GOVT.OF INDIA
To
‘The Chief Personal Officer
‘South Central Railway, Secunderabad - 500003,
date.19. 06/9019
Sub : Declaration for the nomination
.4s a permanent group * ...[)...."
Division, Ihave already passed all the
TARA Ana LAkcH re
| shall be hight obliged ifyou alow my prayer and take necessary action as soon as possible
‘Yours faiehfuls,
(Full Signature of the Stat)
A Predra kismet
RegNo(Roll No.) LBQLANGQAGS YO246
Full Signature of the Nominee
Breer) GOVT OF INDIA
7 SOUTH CENTRAL RAILWAY
© afar yaa
Residential Proof Certificate
lam iieniss ars... DODDT: ARVORA. KUMAR
Za00wo DODDE: KOTES MAREE RAD (12S? sermanertresitental address
\
pvt Hangalopalem ro Hangalapal"S _kothaval so.
Dist. VIFL YOu. Pin Code... 535183. (with State) Contact no.
am 1052045020, TAT yarns ace
sw Mangalopalem- oHangalopal’2 kothavalsa
Dist. sine 53S AZZ (with state)contact no,(# any)
Josaouso2®, STO code)
Family Information
a) Local Guardian's Name... DORDI.... SEMA. CHALAL..........
b) Relation with local Guardian... ATHERS: .GROTHER...
©) Moctly Focsily EI asta 21 ENED
‘The above declaration is true and such to the best of my knowledge.
Dae: 19 [06/2019 Ar Ay, 400K
Pace: Hangalepalemn c taal”
Certified bv : Ve
ab. inti” ia
mane : "SiAnas ball sigh. Schoo!
ae Mangalapalem, Kothavalasa Mandal
Vizianagaram Dist. Pin-535 183
Kothaval2 SOUTH CENTRAL RAILWAY
MEN FOR)
Name (Capital Lanes) ; DODOE:.
Fails Husbands Name: ... DOODE.:.KOTESWLARARAO..LLA
Permanent Address
\fzianagram.,
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