Passport size
photograph to
be affixed.
1.
2.
3.
4.
5.
6.
Nationality at birth
7.
8.
Do
you
belong
to
Scheduled :
Caste/Scheduled
Tribe/Other
Backward
Class
recognised
by
Government? Give the particulars as
to which of them you belong to.
9.
2
(b) If the answer to (a) is 'Yes', Do :
you have (i) more than one wife living (if a :
male)?
(ii) has married a man already having :
another wife (if a female)?
10.
Number of children
11.
Particulars of Qualification
commencing with Matriculation/
S.S.C. or equivalent Examination /
H.S.S.C.and then of Graduation, Post
Graduation etc.
: Name of
the
Board/
Universit
y
S.S.C.
H.S.S.C
Graduation
Post Graduation
M.B.A.
or
Advanced
Diploma
Year of
Passing
Division
with
percentage
of marks
in :
General Management.
Any other qualification
12.
Details
of
Computer
undertaken and Qualified
:
Duration
Course/s : Name of Name of
the
the
Computer Institution
Course/s
:
13.
14.
15.
3
16.
17.
18.
D.D.No...........date........................
:
Amount ........Issuing Bank and place
Date : ........................2014
D E C L A R A T I O N
Date : .......................2014
D E C L A R A T I O N
FORM A
I, Shri/Smt./Kum. _________________________________________
son/daughter/wife of Shri. ______________________________________
aged______ years, resident of ___________________________________
____________________ do hereby declare as follows :1. That I have applied for the post of ____________
2. I have _______________ (Number) living child/children as on today
out of which _______ (Number) child/children is/are born after 28 th
April, 2005 is ________________ (If yes, mention dates of birth).
3. I am aware that, if total number of living childern are more than two
due to the children born after 28 th April, 2006 I am liable to be
disqualified for the said post.
Place :
Date :
(Signature)