Candidate Attestation Form

PERSONAL DETAILS

1. (a) Name in full (capital letters only) with aliases, if any. Please indicate if you have added / dropped at any stage any part of your name / surname.
(b) Designation of the candidate with category (Appointment by Direct recruitment / Ex-Servicemen quota / compassionate ground)

Enclose supporting certified copies of the documents.

2. Details of Address

a. Present Address

Contact Phone numbers - Landline/Mobile

b. Permanent Address

Contact Phone numbers - Landline/Mobile

(c) If originally a resident of Pakistan, the address in that dominion and the date of migration to Indian Union.


PARTICULARS OF THE RESIDENTS

3. Particulars of the places where you have resided during the preceding five years from the date of filling up Attestation Form.
Year 1

Residential Address in full

Year 2

Residential Address in full

Year 3

Residential Address in full

Year 4

Residential Address in full

Year 5

Residential Address in full

OTHER PERSONAL DETAILS

4. Father’s Details
d) Present postal address (if dead, give last address)
e) Permanent postal address
5. (i) Nationality of:
6. Date of Birth of the Applicant
7. Place of birth of applicant, district and state
8. Religion

Specify the Class/Tribe Grade

CANDIDATE EDUCATIONAL DETAILS

9. Educational qualifications showing places of education with years in schools and colleges since 15th year of age (Please enclose certified copies of Study Certificates and indicate whether study is regular or distance / correspondence).
1. SSC/Matriculation
2. Intermediate/Diploma
3. Graduation/Professional course
4. Post Graduation
5. Any other qualification
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6. Entrance Exam Hall Ticket

EMPLOYMENT DETAILS

10. If you have at any time been employed, give details (Please enclose certified copies of the documents).

Have you been at any time dismissed?

Have you been at any time removed from service?

Have you been at any time resigned to the post?

Add More Employment

11. LEGAL TERMS

Have you ever been arrested by the police, convicted by a Court of law or detained under any state / central preventive detention laws for any offence? Whether such conviction sustained in the Court of Appeal or set aside by the Appellate Court if appealed against.

If detained, convicted, debarred etc. subsequent to the completion and submission of this form, the details should be communicated immediately to the concerned Department or the authority to whom the Attestation Form has been sent earlier, as the case may be, failing which it will be deemed to be suppression of factual information). If the answer is ‘Yes’, the full particulars of the conviction, sentences and detention should be given.

REFERENCES

12. 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)
Reference-1
Reference-2

13. Have you ever been member/worker of any Political Party or Communal organization/Youth/Student/Service/Labour? If so furnish details.

DECLARATION SHOULD BE SIGNED BY THE CANDIDATE

Signature of the candidate
Min Size: 100px * 100px
  • 29/05/2019
  • Hyderabad

Certified that I have known Sri/Smt/Kum _______ Son/Daughter/Wife of ______for the last ____ years ___ Months and to the best of my knowledge and belief, the particulars furnished by him/her are correct.

Please add the Candidate signed Certificate document as prescribed.

Payment Details

50

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