Revised Attestation Forms for Antecedents Verification - Chittoor

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5. (i) Nationality of : a) Father b) Mother c) Wife/Husband Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate (ii) Place of birth of Wife/Husband 6. a) Date of birth of the applicant b) Present age c) Age at SSC/Matriculation 7. a) Place of birth, District and State b) District and State to which you belong 8. a) Religion Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate b) Are you a member of Scheduled Caste/Scheduled Latest colur Tribe passport / Backward size photograph Class? of the candidate Scheduled Caste Scheduled Tribe Backward Class Please Specify the class/Tribe Lat Grade A,B,C,D, &E est Lat est Lat est 9. Educational Qualifications col showing places of education with col Latest years colur in schools passport and size colleges photograph since of 15 th your of age (Please enclose ur certified copies of study ur certificates and the indicate candidate whether ur study is regular or distance/correspondence) pa pa pa Name of the Date of Date of leaving Examination Police school/College ssp with full entering ssp (Mention passed with ssp Reg. Station Course address ort (village/Mandal/ (mention ort Month & Year) No. etc (Name ort of and District/City) month & the group i.e. Inter/ siz siz District. Degree/ siz Diploma e year) e PG, etc) e 1.SSC/ ph ph ph Matriculation ot ot ot 2.Intermediate/ Diploma ogr ogr ogr 3.Graduation/ ap ap ap Professional h h h Course 4.Post Graduation of of of 5.Any other qualification th e th e th e ca ca ca 10. If you have at any time been employed, give details. (Please enclose certified copies of the documents) ndi ndi ndi Designation of post Full Address of the Have you been at held or description dat Period dat Office, Firm or any time dat dismissed / of work Institution removed from From e To e e service / resigned to the post? If so, please give details
11. Have you ever been arrested by the police, convicted by a Court of law or detained under any state/ Central preventive detention laws for any offence? Whether such conviction sustained in the court of Appeal or set aside by the Appellate Court if appealed against. (Note: If detained, convicted, debarred etc. subsequent to the completion and submission of this form, the details should be communicated immediately to the concerned Department or the authority to whom the Attestation Form has been sent earlier, as the case may be, failing which it will be deemed to be suppression of factual information). If the answer is ‘Yes’, the full particulars of the conviction, sentences and detention should be given. 12. Name and complete address of two responsible persons of your locality to whom you are known or two referees to whom you are known. (Persons shall not be blood relatives) Referee-1 Referee-2 House /Apartment/Flat No. Name of the Apartment/complex Lane Name Street & Road Village Mandal/Taluk Town/City District State Pincode Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size photograph of the candidate Latest colur passport size Latest colur passport size photograph of the candidate photograph of the candidate 13. Have you ever been member/worker of any Political Party or Communal organization /Youth/Student/Service/Labour? If so furnish details.
Page 1 and 2: ANDHRA PRADESH STATE ROAD TRANSPORT
Page 3: Pincode Contact Phone Number Mobile

Revised Attestation Forms for Antecedents Verification - Chittoor

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