GOVERNMENT OF ASSAM

STATE LEVEL POLICE RECRUITMENT BOARD, ASSAM

REHABARI::: GUWAHATI

(NO APPLICATION FEE IS APPLICABLE)

APPLICATION FORM

ADVT NO: SLPRB/ REC/JA-STENO/2018/159 APPLY DATE: 17-MAY-2020

APPLICATION NO. NAME: DATE OF BIRTH:

JRA22393 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 :

JUNIOR ASSISTANT DISTRICT LEVEL (PREFERENCE 1)
JUNIOR ASSISTANT ASSAM POLICE HEAD QUARTERS (PREFERENCE 2)

PERMANENT ADDRESS CORRESPONDENCE ADDRESS

VILL KHARIDAL PO HATIPARA PS CHHAYGAON DIST KAMRUP ASSAM PIN CODE VILL KHARIDAL PO HATIPARA PS CHHAYGAON DIST KAMRUP ASSAM PIN CODE
781137 781137

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

KAMRUP CHAYGAON 781137 KAMRUP CHAYGAON 781137

ACAMEDIC QUALIFICATION: EXTRA CURRICULAR ACTIVITIES:

STENOGRAPGY
COLLEGE NAME: COMPUTER CERTIFICATE
CERTIFICATE
CHHAYGAON COLLEGE YES
NA

QUALIFICATION: DEPARTMENT: PERCENTAGE: EWS CERTIFICATE

GRADUATE COMMERCE 55 % 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.