Nashik Rural
Application cum Personal Particulars Form for Character & Antecedents Verification
पतत : वतरषष पपललस तनरलकक , Wavi P. Station पपललस षठणण.
खठललल नममद ममददठदवर अररदठर रठधव
Nashik Ruralकदपनलचण Nashik Ruralनठव SELF यठदचल चचकशल करन ममळ कठगदपतठदसह अहवठल पडतठळणल शठखठ,
तव. शठखठ,Nashik Rural यणथण सठदर करठवठ.
१) अररदठर तदलणलयठ पततयठवर कणवहठपठसमन रठहत आहण ?
२) अररदठरठतवरद आपलण पपतलस षठणयठचण अतभलणखठवर गमनहण , आकणपठहर ननदल आहण त कठ?
असलयठस गमनहठ ननद क., कलम,कपरर ,कपरर कणस क. व गमननठचल सदससथतल कळवठवल.
रठवक क. /तवशठ/पडतठळणल/तद. / /२० पपउप आयमकत, तव.शठ.Nashik Rural कतरतठ
Applicant's Name JADHAV MANOJ BABURAO Application ID NSGR11241000353
ID Name Others ID No 676513019970
Aadhar Card No. Mobile No. 9373008736
Email ID
Present Residential Address
DODI KH DODI BK SINNARNASHIK Dodi Kh. Sinnar Nashik MAHARASHTRA-422606
Previous Address
Do you need to verify your previous address
Address
Native/ Permanent Address
DODI KH DODI BK SINNAR NASHIK Dodi Kh. Sinnar Nashik MAHARASHTRA 422606
Company Name and Address where NOC/ Certificate is submitted
Designation SELF Company SELF
Address DODI BK DODI KH SINNAR NASHIK Dodi Kh. Sinnar Nashik MAHARASHTRA 422606
Particulars of places where the Applicant has resides during last 10 years
Sr. No Address From To Pincode
1 AT DODI KH POST DODI BK TAL SINNAR 12/1998 10/2024 422606
Present Occupation / Service ( Joining date, Post, Office Address & Telephone)
05/11/2024
Visible Identification Mark
Have you been Arrested / Prosecuted? If yes, give case details ( C.R. No. & P.Stn )
No
Have you been Active in Politics? If yes, give details of the party / organisation.
No
Is there any Criminal Offence registered against you?
No
Name, Address & Signature of two persons in your locality who knows you.
Name & Address Mobile No.
VITTHAL KARDEL AT POST MANORI 9922829582
JADHAV SACHIN DODI BK 7410550992
I hereby solemnly state that information provided above by me is true and correct.
Place SINNAR
Date 05/11/2024 Applicant's Signature
