Application Form Identity certificate .pdf

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Original filename: Application_Form_ Identity_certificate.pdf
Title: Microsoft Word - Application Form Identity certificate.docx
Author: 00059114

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Post Applied for :____________________

Affix recent passport
size photograph
Identity should be
certified by an officer as
mentioned in the
advertisement with
designation / seal of

1. Full Name

: ______________________________________________

2. Father’s Name


3. Permanent Address

: ______________________________________________


4. Address for Correspondence /
Present Address

: _____________________________________________

5. Date of Birth : ________________

6. Sex : Male :

Female :

7. Religion : ___________________

8. Nationality : ____________________________________

9. Domicile : __________________

10. Category:






11. Ex-Serviceman
Date of Joining Service



Date of Discharge from Service



12. E-mail id



13. Telephone No. (With Std Code)



14. Mobile No. (If any)




Page 1 

15. Educational Qualification :

Percentage of

Year of Passing

16. Experience :

Name of the


Nature of duties



17. If employed in Govt. Dept. / PSU, whether applied through proper channel : Yes / No.
18. DD No. __________ Date.___________________ Name of Issuing Branch _____________
Branch Code No. __________________.
Declaration : I hereby declare that all statements made in the application are true, complete and correct to
the best of my knowledge and belief. I also undertake that I have not submitted applications for two
different posts advertised. The relevant clause is stated below for easy reference :- “Candidates can
apply against any one post only. Candidates applying for more than one post will not be considered and
such applications will be rejected.”

I understand that in the event of any information being found untrue /

false / incorrect or I do not satisfy the eligibility criteria, my candidature / appointment will be cancelled /
terminated, without assigning any reasons thereof.

I have read the contents of the advertisement and

agree to abide by the rules, regulations and procedures for appointment to the post applied for.

Date :

Place :


(Signature of Applicant)

Page 2 

Affix photograph
Seal of office & Signature of the
officer attesting this certificate
should appear on the

This is to certify that the details and photograph of Shri _________________________
S/o._________________________________________________ and resident of (R/O)
who has applied for the post of __________________________________________ is
verified and certified as correct and genuine.
Signature of the Candidate



Signature of the Certifying Officer:


Name of Certifying Officer



Phone No. of Certifying Officer



(Seal of Office )



[Note : Identity of the Candidate should be certified by an Officer not below the rank of
Tehsildar / Sub-Divisional Officer of the candidate’s domicile place / native place, Principal
of the school / college from where the candidate has passed his 10th Standard, Intermediate
or Graduation / Diploma along with name, designation and seal of office.]

Page 3 

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