Government of Assam: State Level Police Recruitment Board, Assam Rehabari::: Guwahati

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GOVERNMENT OF ASSAM

STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM


REHABARI::: GUWAHATI

(NO APPLICATION FEE IS APPLICABLE)

APPLICATION FORM
SLPRB/REC/FOREST/GD-III/1081/2020/179 APPLY DATE: 25-MAY-2020

APPLICATION NO. NAME: DATE OF BIRTH:


FRST16217 ABINASH DAS 02-08-1992

FATHERS' NAME: MOTHERS' NAME: CASTE:


LATE JATINDRA NATH DAS DIPTI DAS GENERAL

EMAIL: PHONE: ADD. PHONE: GENDER:


ABINASHDAS4UONLY@GMAIL.COM 8638528772 NA MALE

NATIONALITY: RELIGION: EMPLOYMENT NO. :


INDIAN HINDU PEO-75/16

POST APPLIED FOR :


FORESTER-I (PREFERENCE 1)

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

C/O-MUKUL KUMAR CHOUDHURY VILL & PO-BHAWANIPUR DIST-


C/O-MUKUL KUMAR CHOUDHURY VILL & PO-BHAWANIPUR DIST-BARPETA STATE-ASSAM PIN-781352
BARPETA STATE-ASSAM PIN-781352

DISTRICT: POLICE STATION: PIN: DISTRICT: POLIOCE STATION: PIN:


BARPETA BARPETA 781352 BARPETA BARPETA 781352

ACAMEDIC QUALIFICATION

COLLEGE NAME: QUALIFICATION: DEPARTMENT: PERCENTAGE:


ICFAI UNIVERSITY TRIPURA GRADUATE OTHERS 88.2 %

EXTRA CURRICULAR ACTIVITIES

ELEPHANT
STENOGRAPHY DRAFTSMAN DRIVING
UPKEEPING CARPENTRY CERTIFICATE NCC CERTIFICATE
CERTIFICATE CERTIFICATE CERTIFICATE
CERTIFICATE
NA NA
NA NA NA
NA

COMPUTER HOME GUARD SPORTS


EWS CERTIFICATE EMPLOYMENT EXCHANGE CERTIFICATE
CERTIFICATE CERTIFICATE CERTIFICATE
NA YES
YES NA NA

DECLARATION:
It is certified that above particulars are true to my knowledge and belief. Further, I understand that if any of the above particulars is found false, my
candidature will be automatically rejected.

NOTICE:
Candidate should check all the data entered in the application form very carefully. Any issue noticed, candidate may contact recruitment Help Desk Tel: 7636071991, 7636071992, 7636071993 (09:00am -
06:00pm) or Email: slprbrect@gmail.com.

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