Application Form: Aspirational Blocks o Pufaoc ‘ABP Fellow) ry ser flusy BLOCK: pub prepgat.—. My 1. | Name of Applicant Foe al Z._| Applicant's Father's Name CORV CHAM BIL. 3,_| Catagory (GEN/OBCISCIST) Once wel) 4] Date of Birth (Date/Month/Year) |.04 / O €!' 14? 5. | Gender pase 6. _| Mobile Number ESE 294 FL 7, | E-Mail ld : Provest bane rivgh v0 1 gr 1) Ore 8. Marital Status 1 Unma wv} CS. 9, | Current Postal Address (Fer 4 arhy Village/Ward Eade2 g Yr Block/Tehsil Pafrg art District aye State Lapa stir: 7 Pin Code C 2 4-50 27) Educational Qualification- SNO | Educational Bead Unnesy [Passing ] Score! ase r— MD Load, VIS D8 1 | High School DP Baad 20 (4- as 2 | Higher Secondary Panwa Tiel Z . L642 yy 3. | Graduate Bo Jrannels HMlabe2 a / : NL mm Wyo hs 4 (pos Gdtne’ | [nae cant | ba vee axa 420 14 Ozy Other Uniretl : } Qualifications | naeey: ao (Data Analysis / Computer Proficiency certificate - S.No] Certificate/Diploma/Degree | Institution Name |, Affiliation noe car NNT Work Experience- S.No.| Particulars | Designation | fasttution | Job | __ Period cast 3 r v | hous ware 7 COE GET) orem ite, Pay wate Fie KD MALL By brs Preise Pe UPL = Pov Certificate related to Project Management skills or work Period Total ff FROM To | Year S.No. | Institution / Name of Subject/Skill I PF seo ) | MEER bea dertubhe lai Hag a fol2S Vela SELLY LG Toru ory 302% I hereby declare that 1 fulfil the eligibility condition mentioned in the advertisement and guidelines of ‘Aspirational Blocks Fellow (ABP Fellow 2024) and that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. | understand that in the event of any information being ound false or incorrect at any stage of not satisfying the eligibility conditions mentioned in the advertisement an guidelines of Aspirational Blocks Fellow (ABP Fellow 2024), my candidature will liable to be cancelled terminated. Talso understand and declare that this is purely a fellowship and does not provide any type of employment or guarantee for any employment in futurc. 1 will not claim any employment in future from Government Department on this ground. ‘ Enclosed:- Name of Candidate wetle Jeomorf bie