CENTRAL SELECTION BOARD OF CONSTABLE, BIHAR, PATNA
31 B7A 3 A 4 076/ 1 @A/0:3 /EHG F (
ACKNOWLEDGEMENT
POST APPLIED FOR : 1 @A/0:3 DATE & TIME : ( - -
REGISTRATION ID : 80934606
APPLICANT NAME : @/916/ / /D/ FATHER'S NAME : 0 783 2 / / /D/ @7 56
MOTHER'S NAME : @ 7A7 7D/ NATIONALITY : INDIAN
MOBILE NUMBER : ( ()() EMAIL ADDRESS : @/916/ / D/ .5 /7: 1
ARE YOU A DOMICILE OF BIHAR STATE : YES CATEGORY : EBC
ARE YOU HOMEGUARD OF BIHAR STATE: NO
GENDER : MALE DATE OF BIRTH : 31-01-2005
MARITAL STATUS : UNMARRIED
AADHAR NO : ( ( ) IDENTIFICATION MARKS : / :3 / 9 2 C : C3 :7
ARE YOU A WARDS OF FREEDOM FIGHTER? NO
EDUCATION QUALIFICATION DETAILS
EXAM PASSED UNIVERSITY/ BOARD ROLL NO CERTIFICATE ISSUED DATE
10 BSEB PATNA ) (
10+2 BSEB PATNA )
ADDRESS DETAILS
PERMANENT ADDRESS CORRESPONDENCE ADDRESS
HOUSE NO HOUSE NO
STREET/MOHALLA 26 /7D/ @ 26 /7D/ STREET/MOHALLA 26 /7D/ @ 26 /7D/
VILLAGE/TOWN 0/@07AA/ VILLAGE/TOWN 0/@07AA/
POST OFFICE 26 /7D/ POST OFFICE 26 /7D/
DISTRICT 0/ 9/ DISTRICT 0/ 9/
STATE BIHAR STATE 076/
PIN CODE PIN CODE
DECLARATION OF CRIMINAL CASES
HAVE YOU EVER BEEN DEBARRED BY UPSC, SSC OR SPSC OR ANY RECRUITMENT BOARD FROM APPEARING IN ANY EXAM?
CRIMINAL PROCEEDING DETAILS, IF ANY
A) WHETHER ANY FIR OR CRIMINAL CASE(S) HAS EVER BEEN REGISTERED AGAINST YOU? NO
B) WHETHER ANY CRIMINAL COMPLAINT CASE OR FIR OR CRIMINAL CASE(S) IS PENDING AGAINST YOU IN COURT OF LAW,
NO
OR WITH POLICE AT THE TIME OF SUBMITTING THE APPLICATION FORM?
C) HAVE YOU EVER BEEN ARRESTED/DETAINED IN ANY CRIMINAL CASE(S)? NO
D) HAVE YOU EVER BEEN TRIED & CONVICTED OR ACQUITTED BY A COURT OF LAW IN ANY CRIMINAL CASE(S)? NO
E) HAVE YOU EVER BEEN TRIED & CONVICTED BY THE COURT BY FILLING ANY BOND FOR GOOD BEHAVIOUR ETC.? NO
DECLARATION BY THE CANDIDATE
I HEREBY DECLARE THAT THE INFORMATION GIVEN ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND NOTHING HAS BEEN CONCEALED THEREIN. I AM WELL
AWARE OF THE FACT THAT IF THE INFORMATION GIVEN BY ME IS PROVED NOT TRUE, I WILL HAVE TO FACE THE CONSEQUENCES AS PER THE LAW. ALSO, ALL THE BENEFITS AVAILED
BY ME SHALL BE SUMMARILY WITHDRAWN.
English Signature Hindi Signature
