Verification form

(as per Notification No. 1573/WBBPE/2022 dated 29-9-2022, 1573(PART-1)/WBBPE/2022 dated 21-10-2022and
1828/WBBPE/2022 dated 10-11-2022. and recommendation of WBBPE Vide. Memo No.-134/WBBPE/2024 dated 3-2-2024.)

(Give tick marks)

Medium:- BEN//HINDI/URDU/SANTALI Category:- EXEMPTED/NON-EXEMPTED/PH/EX-SERVICE MAN/PARA
Caste-GEN/SC/ST/OBC-A/OBC-B Sex:- MALE/FEMALE

1. NAME OF THE CANDIDATE :-

2. Father/ Husband Name :-
3. Date of Birth(DD/MM/YYYY):-
4. Mobile No. :-
5. Email. Id :-
6. Registration No. :-
Attachments:-
7. TET Roll No. :-
Photocopies 8. Details of Address with Post office and Pin Code(As per TET Admit):-
of

1.TET ADMIT
9. Aadhar Card No. :-
2.TET PASS 10. Details of Address with Post office and Pin Code(As per Aadhar Card):-
CERTIFICATE

3. MP ADMIT
11. Academic Qualification:-
4. AADHAR
CARD
SL Level Board/ Year of Subjects Full Marks Percentage Remarks
NO Council/ Passing Marks obtained
5. Caste University
Certificate (if X
applicable) 1 Level
6.All
qualification
Marksheet &
2 XII
Certificates of
Level
academic &
Professional
Certificate 12. Professional Qualification:-
6. Documents
▪ Name of Professional Course:-
of Specific ▪ Name of Institution :-
category (if ▪ Year of Passing :-
Applicable) ▪ Marks :-Marks obtained- Full Marks:-
13. Para Teacher :- Not Applicable/ Primary Para Teacher/ Upper Primary Teacher.
Name of School(if Para Teacher)-

Place:- Purulia DPSC Full Signature of Candidate with Date

(For Office Use) Comment after Verification:-

Verified by (Full Signature)