Application Form Identity certificate .pdf
Original filename: Application_Form_ Identity_certificate.pdf
Title: Microsoft Word - Application Form Identity certificate.docx
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Post Applied for :____________________
Affix recent passport
Identity should be
certified by an officer as
mentioned in the
designation / seal of
1. Full Name
2. Father’s Name
3. Permanent Address
4. Address for Correspondence /
5. Date of Birth : ________________
6. Sex : Male :
7. Religion : ___________________
8. Nationality : ____________________________________
9. Domicile : __________________
Date of Joining Service
Date of Discharge from Service
12. E-mail id
13. Telephone No. (With Std Code)
14. Mobile No. (If any)
15. Educational Qualification :
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.
(Signature of Applicant)
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.
PERMANENT ADDRESS :
PRESENT ADDRESS :
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.]
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