GOVERNMENT OF ASSAM

STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM

REHABARI::: GUWAHATI

(NO APPLICATION FEE IS APPLICABLE)

APPLICATION FORM
SLPRB/REC/EXCISE/ASI & CN/2019/135 APPLY DATE: 19-07-2020

APPLICATION NO. NAME: DATE OF BIRTH:

EXC259403 MATIBAR RAHMAN 11-01-1994

FATHERS' NAME: MOTHERS' NAME: CASTE:

MAKBUL ALI MAIRUM BIBI GENERAL

EMAIL: PHONE: ADD. PHONE: GENDER:

MATIBAR89@GMAIL.COM 8011849899 NA MALE

NATIONALITY: RELIGION: EMPLOYMENT NO. :

INDIAN ISLAM 16705/15

POST APPLIED FOR :

ASSISTANT INSPECTOR OF EXCISE (PREFERENCE 1)
EXCISE CONSTABLE (PREFERENCE 2)

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

C/O MAKBUL ALI VILL KHARIDAL PO HATIPARA C/O MAKBUL ALI VILL KHARIDAL PO HATIPARA

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

KAMRUP CHAYGAON 781137 KAMRUP CHAYGAON 781137

ACAMEDIC QUALIFICATION

COLLEGE / SCHOOL NAME: QUALIFICATION: STREAM: PERCENTAGE:

CHHAYGAON COLLEGE H.S COMMERCE 63.6 %

EXTRA CURRICULAR ACTIVITIES

COMPUTER HOME GUARD SPORTS

NCC 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.