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Note : Please Download the Antecedent Verification Form and submit 2 copie's of
the same duly signed by you at the time of Verification

Antecedent Form

Personal Details

VSWS HallTicket Number 190204000628

Applicant Name ARIGI PAVAN KUMAR

Post Applied POSTS UNDER CATEGORY - II GROUP - A

Date Of Birth of Applicant 27/10/1998

Mobile 9951326807

Religion HINDU

Community BC-D

Community Sub Caste Turupukapus or Gajula kapus

Paturu village, VEPADA mandal,

Place Of Birth
vizayanagram DIST

District To Which Belong VIZIANAGARAM

Martial Status UNMARRIED

Present District VIZIANAGARAM

2-91,VINAYAKA
Present Address
STREET,PATURU,VEPADA,535161

Permanent District VIZIANAGARAM

2-91,VINAYAKA
Permanent Address
STREET,PATURU,VEPADA,535161

PRECEEDING RESIDENTIAL DETAILS

From To Police Station

Sl.No Residential Address
Month/Year Month/Year & District
 PRECEEDING RESIDENTIAL DETAILS

From To Police Station

Sl.No Residential Address
Month/Year Month/Year & District

VEPADA POLICE
2-91, PATURU VILLAGE, VEPADA
STATION,
1 06/2014 06/2015 MANDAL, VIZAYANAGRAM DIST.
VIZAYANAGRAM
535161
DIST.

VEPADA POLICE
2-91, PATURU VILLAGE, VEPADA
STATION,
2 06/2015 06/2016 MANDAL, VIZAYANAGRAM DIST.
VIZAYANAGRAM
535161
DIST.

VEPADA POLICE
2-91, PATURU VILLAGE, VEPADA
STATION,
3 06/2016 06/2017 MANDAL, VIZAYANAGRAM
VIZAYANAGRAM
VIZAYANAGRAM. 535161
DIST.

VEPADA POLICE
2-91, PATURU VILLAGE, VEPADA
STATION,
4 06/2017 06/2018 MANDAL, VIZAYANAGRAM DIST.
VIZAYANAGRAM
535161
DIST.

VEPADA POLICE
2-91, PATURU VILLAGE, VEPADA
STATION,
5 06/2018 11/2019 MANDAL, VIZAYANAGRAM DIST.
VIZAYANAGRAM
535161
DIST

Father Details

Father Name ARIGI KANNAYYA

Profession/Job No

Postal District VIZIANAGARAM

Postal Address 2-91,VINAYAK STREET,PATURU,VEPADA,535161

Permanent District VIZIANAGARAM

Permanent Address 2-91,VINAYAK STREET,PATURU,VEPADA,535161

EDUCATION QUALIFICATION DETAILS

Examination
Name Of Police
Entering Leaving RegNo &
Course School/College Station &
Date Date Passed
Address District
Details

VIGANANA JYOTHI
HIGH S.KOTA,
SSC/Matriculation SCHOOL,S.KOTA, 06/2007 03/2014 1406105949 VIZAYANAGRAM
VIZAYANAGRAM DIST
DIST.

GOVERNMENT
POLYTECHNIC
Intermediate/Diploma COLLEGE 09/2014 04/2017 14013-C-207 VIJAYAWADA
VIJAYAWADA,
KRISHNA DIST .
 EDUCATION QUALIFICATION DETAILS

Examination
Name Of Police
Entering Leaving RegNo &
Course School/College Station &
Date Date Passed
Address District
Details

Graduation/Professional
--- --- --- --- ---
Course

Post Graduation --- --- --- --- ---

Any other Qualification --- --- --- --- ---

Case Details

Is Arreted By Police.convicted by Court

No
Of Law Under any state/central Laws

Have you ever been arrested No

Have you ever been prosecuted No

Have you ever been kept under detention No

Have you ever been bound down No

Have you ever been fined by a Court of

No
Law

Have you ever been convicted by a court

No
of Law

Have you ever been debarred from any

examination or rusticated by
No
any university or any other educational
authority/institution

Have you ever been debarred

/disqualified by any Public Service
Commission/Staff Selection No
Commission/or any other recruitment
board for any of its examination/selection

Is any case pending against you in any

court of law at
No
the time of filling up this Antecedents
form

Is any case pending against you in any

University or other educational
No
authority/institution/ at the time of filling
of this Antecedents Form?

Whether discharged/expelled/with drawn

from any training/institution under No
the Government or otherwise?

RESPONSIBLE PERSON DETAILS

First Preference Second Preference

Name in Full Sur Name SANAPATHI GANAPATHI DWARAPUDI APPALASWAMI

Given Name If Any -- --

 RESPONSIBLE PERSON DETAILS

First Preference Second Preference

Fathers Name SANAPATHI NAGESWARA RAO DWARAPUDI RAMASWAMI

House/Apart/Flat No 2-90 1-59

Street and Road VINAYAKA STREET YSR STATUE ROAD

Village PATURU PATURU

Mandal/Taluk VEPADA VEPADA

Town/City PATURU PATURU

District VIZIANAGARAM VIZIANAGARAM

Pin Code 535161 535161

Urban/Rural RURAL RURAL

DECLARATION DETAILS
1. I hereby declare that the statements made In this form are true to the best of my
knowledge and belief.
2. I am married / unmarried and have only one wife living ( delete which Is not applicable).
3. I am fully aware that furnishing of false Information or suppression of any factual
Information in the Antecedents Form would be a disqualfication and is likely to render me
unfit for employment under the Government.
4. I am also fully aware that If It comes to notice at any time during my service that false
Information has been furnished or that there has been suppression of factual Information in
the Antecedents Form, my services would be liable to be terminated solely on this ground.
Date Signature of the Candidate
Place (Full Name:                  )

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