PRODEDURE FOR FILL.

UP THE CHARACTER AND ANTECEDENTS

POLICE VERIFICATION FORM (ATTESTATION FORM)

The following instructions must keep in mind by candidates, while filling up the
Character and antecedents Verification Form (Attestation form) before submitting in
PEB Branch, Police Headquarters, Sector- 9, Chandigarh :-

1. The candidates must complete the form in own writing. The candidates must
mention the complete address in all forms, i.e. Vill, PO, Tehsil, Police Station,
Distt & State with PIN Number.

2. All forms will be filled up in ink signed, no photocopy of filled from is accepted.

3. Candidate must write the Roll No, Category Serial No and contact No on the top
of the all forms.

4. All forms will be complete in all respect and no column will be left blank in the
forms.

5. ln the all forms at Ser No 4 (a), (b), (c), (d) & (e), the data will be filled up of
father or in case of married female, her husband name & particulars in case of
married female.

6. All Forms and photographs should be attested by Gazzalted Officer.

7. lf the candidates have one address, he will submit Four (04) Forms.
lf the candidates have two addresses, he will submit Seven (07) Forms.
lf the candidates have three addresses, he will submit Ten (10) Forms.

8. lf any enquiry, please contact to PEB Branch, Phone No : 0172-2760937.

:0172-2740495.
 ATTESTATION FORM
Photograph duly
attested by
Gazetted officer

1. Name in Full (in block letters)

Also indicate if any letter has
been added or dropped
at any time in your
name or surname.

2. Present address in full

i.e. H. No. Village,
Post office, Police station,
Tehsll, District, State

3. Particulars of places
where you have resided
during the proceeding
five (5) years

s. From To Address
No.
I

ii

iii

4. a) Father's/Husband's Name in full with @ if any

b) Present Local Add

c) Permanent Home address_

d) Profession

e) Give official address/

designation if serving any where.

5. Nationality Father's Mothe r'r

Husband's--
6. a) Date of passing matriculation examination

b) Present age_Age at the time of passing matriculation

c) Height-Chest-Mark of identification
7. a) Place of birth, Distt & state in which situated

b) Distt/State in which properties held

c) Distt/State to whom you belong

 d) Are you member of SC/ST/OBC Yes/No

e) If member of SC, state caste/religion

f) If member of backward class state your caste/religi

8. Educational qualification showing place of education with year in school and college since 15 years of
a9e.

S. No. Name of School/ Colleqe Date of enterinq Date of Leavinq Exam Passed
1

2.

3.

4.

9. Are you presently employed? if so give details

10. Have you ever been employed?

If yes, give designation held or
description of work.

11. Are you EX ECO/ESSCO, EX-Serviceman

or likely to be released. State Rank (I) Officers
(II) JCO (III) Other Rank. Indicate the entry/release date
12. Have you ever been involved in a criminal case any where in India? If yes, give
d eta ils:

13. Have you ever been convicted or acquitted by court in any offence? If yes, full particulars of the
conviction and sentences should be give

14. Are you married/unmarried

I certify that the above said information is correct and complete and nothing has been concealed
therein. I am not aware of any circumstances, which may require my fitness foi employment under
government. I understand that if any of the above information particularly in column ll, 1_2 and 13 is
found to be incorrect or concealed, my candidature would stand cancelled for the post of constable
without assigning any other reason/ground as in case I am already appointed, I will be liable to be
terminated at any time without any notice.

Signature of Candidate

Place--_-_-.-Date-
certificate to be signed by a Gazetted officer or a member of Legislative Assembly or other
authority prescribed by the appointing authority.

Certified that I have known to Sh./Miss/Smt_ s/o, D/O, W/O

for the last years _ months and that to the best of my
knowledge and belief, the particulars furnished by him/her are correct.

--

Place.-_ Sig natu re.

Date Designation
(with seal)

Add ress
 VERIFICATION OF POLICE RECRUIT

Name of Recruit No. /CP

Father 's Name Caste
Village P.O PS Distt
S. Question Answer
No.
1. Are the particulars in this roll correct? If not,
state which are wronq.
2. Has the recruit assumed name of alias in
addition to the name qiven in the roll ?
3. Is the recruit's character good or bad?

4. Does the recruit belong to the tribe caste

stated in the roll?
5. State if the recruit has ever been convicted
or suspected of a criminal offence. Also give
the name of Lambardar.
6. Is the recruit a member of any communal or
political orqa nization?
7. Has he taken any active part in the political
matter or subversive/extremist activities of
anv type?
B. Does he associate or related to
l/extremist g rou p?
pol itica
9. Does he belong to SC/ST?

10. Has he been previously employed either in

private or Govt, service?
11. What was the reason for leaving the service
or his discharge?
12. Was his character previously verified?

13. How long has this recruit and his family lived
in this village?
L4. vvnere was ne born and when?

15. vvnere was ne educated? Give name of the

school and colleqe.
16. lArL^!
vv r roL L--rds ne
r
r r
Deen clolng since leavinq
77. 'orve dr tnrormauon which has a bearing on
the suitability or otherwise of the candiiate
or emploved.

Dated :
Inspector / Sub Inspector
Police station