Technician I (Tele) RRB Clalda Roll -232245310493 868 Mob - 1462995486 ATTESTATION FORM Va) [fon wan Slee any. Sores. coon vine yet ae oEnals ACMAN RAAT wana ‘Tho furnishing of false information or suppression of any station ‘Form would be & fender the candidate unl for hhas been sent early, falling which twill ba doomed to be 9 ‘suppression of factual infermation. |W tho fact that false Information has beon furnished or that tore has been suppression of any Information in tho ‘Altestation Form comes to not ‘ime during the service of @ person his services would be Table to bo ferminated.” | Present Address in full (be. Vilage, Thana and District. oF House No,, LanefStree Road | and town AT+P.0-Urlaha , P.S- palast, DIST.-ARARTA , BIHAR, PIN- 85U333, (A) Home Address in full (be. Vilage, Thana and Distrit. or House No, Lane/Streol Road and Town and name of District Headquarters) AT+PO-URLAHA, P.S-~PALAST DIST -ARARIA , RIHAR . PIN ~ 854333, pe ofP_ARARiA , pIN-SSHU3II (@) I originally a vesKdont of PakistarBangladesh (erstwhile East Pakistan) the ‘address in that country fand the date of migration to Indian Union. N/A ‘Aadhaar Card No (it svallabie) 9694 6392 4207 PAN No (If Available) FRC1PR 9364 & ‘Nationality you belong oe | ate TNDIAN 7 [pxeetein | 05/02/1998 [Present ge 27 YEARS S MONTHS ; atmatreutaion — as YEARS — © | Sateinwitetstaed” — | URLAHA,, DIST—ARARLA ,STATE- BIHAR wy [Batetasmeiomicn | DIST ARARIA, STATE -BIHAR.District and State to w! yourFatheroriginaly belong = | PLST- ARARLA , STATE-BEHAR ‘Your religion HINDO | Seheulew caste Seneculed No. ThibelOther Backward Classes? (Answer Yes or No) 70] Pantculars of places (with per the preceding five years. Inc resided for more than one year after atta oT of reskionce] where you have resided for more than one year ata time during stay abroad (including Pakistan), particulars of all places where you have ning the ago of 21 years, shiould be given. Toaidental address hr Tul | Name of the District Headquarer of the place From to Te Vilage, Thona '& | mentionod in the preceding column. Uistet or” House” No. Lane'Streettoad 8 Town T+ Po-Urlaho, $ o1-01-2929/ 24-0725 | ps-palasi, Atarion Dist- Afaria, Qikor TF ‘Nationally ‘Secupation F | Present postal | Permanent Eaiscor, | byeiina | Placeof | employed gv ‘address (f Home itam erby ‘tn Gosigration | deadgWve last | Address Somes) official adress.) ‘aasress) Father /Balkrishnal ‘ fAr-urlaha | at+po-uglaha. gha INDIAN | Arario | Farmer = |Po- Ortaha| prgrig, ath Arart a, Bihar! Gener other (6, vlochana. * +p |AT#Po-Urlahg, AT+Po-Vdaho. Devi INDIAN | A\raria Hovsewife Ps-Palasi,| Ps-paloki Arario.Bihar| Araria, Bihar Spouse N/A - si = = = 7 information to be furnished with regard to son(s) andlor daughters in ease they are studying living in a foreign country: Name Nationality by | Place of | Country in which Date from which Studying [Living Birth & orby | Birth studying /living with | the country mentioned in the domicile Full Address previous column. N/A _ - _ a 13 Educational qualification showing place of education with years in schools and colleges since 15th years of age: Name of School! Date of Date of leaving | Examination Passed College( with Full Entering Address Bright Greer Sct . < 4 fool} 5011 | 2013 Matriculation pornea, Bihar KN-toler College, | Soy | 2045 Sntermediale14 (@) ‘Govemment or State Government or a Semi-Government body or 8 Quasi ‘Government body or an Autonomous body or a public undertaking, ora private firm ‘Are you holding or have any Ue held an appointment under the Cental i/particulars with dates of employment up to-date Y orinstivion? H's, give Designation, Emoluments | Fullname & address | Reasons fr leaving prevou From ENalure ofemployment | of Employer Seven eens | — - N/A _— _— TTB) Tie prewaus employment was undar the Government of nla [State GovemmenJundoriaking owned ot Contated by the Goverment of India or a State Govornment/and Autonomous Body! University ocal Body. F904 had tof sendco on giving one month's noice undor Rule 6 ofthe Central chil Servces (temporary seeeey Rules 1966, or any sinfar coresponding rules, were any disciplinary proceedings tramed against seotee Ralyou been sail upon in explain your conduct in ary matter atthe time you gave notice of [Gtination of sence, or at a subsequent dato(s), before your serice actualy terminated? 75.1) | () | Have you ever been kept under detention? | YesiNo~ | © | Have you ever been arrested? YesiNo~ @ | Have you ever been prosecuted? {ie has a charge sheet In a criminal case been filed against youin | YesiNo~ any court of law) 1@ [Is any criminal case pending against you in any Court of Law at the time of filing up this Attestation Form? Yesiig- (©) | Have you ever been convicted by a Court of law for any offence? Yeuine, [ 1 | Whether discharged/expellediwithdrawn from any training / IN institution under the Government or otherwise? Neen @ | Have you ever been rusticated by any University or any other Yesityo educational authority/institution? (A) | Have you ever been debarred / disqualified by any Public Service Commission / Staff Selection Commission for any ‘Yeellios of its examination/selection? i) Tf the answer to any of the above mentioned question is *Yes” give full particulars of the case/arrest/detention/fine/conviction/Sentence/punishment etc and/or the nature of the ‘case pending in the Court / University / Educational Authority etc at the time of filling up this Attestation Form: Notes: ]() | Please also see the “WARNING” at the top of this Attestation Form i) | Specific answers to each of the questions should be given by striking out ‘yes! or ‘No’ as the case may be16 | Name of two responsible person of your locally or wo references to whom you are known CAmit Kumoxtha) [PGA gern 5 | Amit Komar tha Rangit Kernar ho AT+Po-Urlaha, P.s-Palasi Ar+ po~Urlaha, P-S-palas! Dist Araria. , Bihar, pin-ssyaa3 Dish Ararta, ihat, pin-SS1333 Mob- 9065 156368 Mob- 9955315432 ~ 7 DECLARATION — | cerify that the forgoing information is correct and complete to the best of my knowledge and belief. | am fully aware that by providing false information or suppressing material information vile filing | this form, the authorities have full right to terminate my appointment letter and | am also liable for appropriate criminalcivil/legal action as a consequence. am not aware or any circumstances which pright impair my fitness for employment under Government | aqfor/2025 Place: Aart Qe TO BE FILLED BY THE OFFICE i. Name, Designation and Full Address of the appointment authority. ii. Post for which the candidate is being considered.