(b) Designation of the candidate with category (Appointment by Direct recruitment / Ex-Servicemen quota / compassionate ground) Enclose supporting certified copies of the documents
Particulars of the places where you have resided during the preceding five years from the date of filling up attestation form
Year 1
[Date Here]
[Date Here]
Residential Address in full
12-1-1289/109
[Apartment Name Here]
[Lane Name Here]
[Street & Road Here]
Telangana
Hyderabad
Peoria
Peoria
500027
Nampally
Year 2
[Date Here]
[Date Here]
Residential Address in full
12-1-1289/109
[Apartment Name Here]
[Lane Name Here]
[Street & Road Here]
Telangana
Hyderabad
Peoria
Peoria
500027
Nampally
Year 3
[Date Here]
[Date Here]
Residential Address in full
12-1-1289/109
[Apartment Name Here]
[Lane Name Here]
[Street & Road Here]
Telangana
Hyderabad
Peoria
Peoria
500027
Nampally
Year 4
[Date Here]
[Date Here]
Residential Address in full
12-1-1289/109
[Apartment Name Here]
[Lane Name Here]
[Street & Road Here]
Telangana
Hyderabad
Peoria
Peoria
500027
Nampally
Year 5
[Date Here]
[Date Here]
Residential Address in full
12-1-1289/109
[Apartment Name Here]
[Lane Name Here]
[Street & Road Here]
Telangana
Hyderabad
Peoria
Peoria
500027
Nampally
4. Father’s Details
Krishna Mohan
Bussiness man
-
1703
Apple Lane
39 Peachfield Road
Peoria
Hyderabad
Telangana
500027
1703
Apple Lane
39 Peachfield Road
Peoria
Hyderabad
Telangana
500027
5. Nationality
(i) Nationality of:
Indian
Indian
Indian
Nizambad
6. (a) Date of Birth of the Applicant
26-08-1993
2/4/1983
18 Years
7. (a) Place of birth of applicant, district and state
Nellore,AP
Telangana Hyderabad
8. Religion
Are you a member of Backward Class
Specify the Class/Tribe Grade A
9. Educational Details
Educational qualifications showing places of education with years in schools and colleges since 15th year of age (upload certified copies of Study certificates for the below)
Educational qualifications showing places of education with years in schools and colleges since 15th year of age (upload certified copies of Study certificates for the below)
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If detained, convicted, debarred etc. subsequent to completion and submission of this form, the details should be communicated immediately to the concerned department of the authority to whom the attestation form has been sent earlier failing which it will be deemed to be suppression of information)
12. References
Name and complete address of two responsible persons of your locality to whom you are known or two references to whom you are known. (persons shall not be blood relatives)
1. I hereby declare that the statements made in this form are true to the best of my knowledge and belief.
2. I am married/unmarried and having only one wife living (delete which is not applicable)
3. I am fully aware that furnishing of false information or suppression of any information in the attestation form would be a disqualification and is likely to render me unfit for employment under the government.
4. I am also fully aware that if it comes to notice at any time during my service that false information has been furnished or that there has been suppression of information in the attestation form, my services would be liable to be terminatedsolely on this ground
12-02-2018
Hyderabad
Signature of the candidate
CERTIFICATE TO BE SIGNED BY A GAZETTED OFFICER OR MEMBER OF LEGISLATURE OR OTHER AUTHORITY AS PRESCRIBED BY THE APPOINTING AUTHORITY.
Certified that I have Know Sri [Name Here] Son of [Name Here] for the last 26 years 08 months and to the best of Knowledge and belif, the perticulars furnished by him are correct.