Nagpur Rural
Application cum Personal Particulars Form for Character & Antecedents Verification
पतत : वतरषष पपललस तनरलकक , MIDC Bori पपललस षठणण.
खठललल नममद ममददठदवर अररदठर बनवठलण
Nagpur Ruralकदपनलचण Nagpur Ruralनठव HORIBA INDIA LTD यठदचल चचकशल करन ममळ कठगदपतठदसह अहवठल
पडतठळणल शठखठ, तव. शठखठ,Nagpur 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.Nagpur Rural कतरतठ
Applicant's Name BANWALE MUKESH PARASHURAM Application ID NGGR01211000832
ID Name PAN Card ID No EFFPB2999M
Aadhar Card No. Mobile No. 9307657185
Email ID
Present Residential Address
AT BID GAANESHPUR PO TAKALGHAT TA HINGANA DIST NAGPUR MIDC ROAD NEAR ZP SCHOOLBID
GANESHPUR Bid-ganeshpur Hingna Nagpur MAHARASHTRA-441122
Previous Address
Do you need to verify your previous address
Address
Native/ Permanent Address
AT BID GAANESHPUR PO TAKALGHAT TA HINGANA DIST NAGPUR MIDC ROAD NEAR ZP SCHOOL BID
GANESHPUR Bid-ganeshpur Hingna Nagpur MAHARASHTRA 441122
Company Name and Address where NOC/ Certificate is submitted
Designation HORIBA Company HORIBA INDIA LTD
Address MARUTI SUZUKI KANHOLIBARA ROAD NEAR MANDWA MANDWA Mandawa (535999) Hingna
Nagpur MAHARASHTRA 441122
Particulars of places where the Applicant has resides during last 10 years
Sr. No Address From To Pincode
1 AT BIDGANESHPUR PO TAKALGHAT TA HINGNA DIST NAGPUR 10/1995 12/24 441122
Present Occupation / Service ( Joining date, Post, Office Address & Telephone)
25/12/24
Visible Identification Mark A MOLE ON RIGHT HAND
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.
AKASH SHAMBHARKAR AT BIDGANESHPUR PO TAKALGHAT TA HINGNA DIST NA 8459656358
PARASHURAM BANWALE AT BIDGANESHPUR PO TAKALGHAT TA HINGNA DIST 7507207775
I hereby solemnly state that information provided above by me is true and correct.
Place BIDGANESHPUR
Date 25/12/2024 Applicant's Signature
