TTESTAT ON FORM FOR CHA C ER VER CAT ON D LH ONL

File Number (for office use only) : F. / / -SCA(i) *'"

Name of the Applicant

Designation

Father’s Name

Mother’s Name

Marital Status

Name of Spouse

Blood Group

Place of Birth

Applicant’s. DOB

Gendér

Applicant's Mobite No.

Applicant’s Email ID

”Nationality

Religion

Category
Present Address

Present Address Duration : From (Month) / (Year) to (Month) / (Year)

Police Station
District

Perma.n.ent é .ddress

Permanent Address Duration : From (Month) ./ (Year) to (Month) / (Year)

one year at a time during the

D..,. ,. ,.
 Educational Qualification

Details of Course **

Employment History:
Periods _ _D_esig¡iation, Eull name & Reasons for
From To emolument & nature Address of leaving previous
of employment employer service

Name and address of two responsible persons of your locality or two references to whom you are
known:
1.

2.

Details of family members/relations already working in the Supreme Court of India:

Name: Designation:

Criminal History

Case details (if any):

FIR No: Foiice Station: Siatus:

! certify that the foregoing information is correct and complete to the best of my knowledge and
belief. I am not aware of any circumstanGes which might impair my fitness for employment to this
Registry of Supreme Court of India.

Signature of the Candidate

Date Place