HIGH COURT OF BOMBAY

Testing Application Form for The Post of CLERK

Registration-ID :- CLK5639

Name of the Applicant :- ATUL VILAS MANE

Address for correspondence :- MANE GALLI, DANOLI

TAL-SHIROL
DIST-KOLHAPUR
District of Postal Address :- KOLHAPUR - 416101
Aadhar No. :- 557208851173

Contact Nos. :- Telephone :- 02322233924 Mobile :- 9689440287

Email :- atulmane99@gmail.com

Nationality :- Indian

Gender :- Male

Religion, Category/Caste :- Hindu, General (MARATHA)

Date of Birth :- 03/06/1991

Age as on 23/12/2021 :- 30 Years 6 Months 20 Days

Marital Status :- Married

No. of Living Child/Children 1
Child/Children born after 28/03/2005 1

Whether Candidate is :- No
Differently-abled Person?

Educational Qualification :-

Course/Degree Board/University Year of Marks out of Percent

Passing Obtained Marks %
S.S.C. PUNE BOARD 2007 410 650 63.08
H.S.C. (Arts) PUNE BOARD 2009 291 600 48.50
Graduate (B.A.) SHIVAJI 2012 954 1800 53.00
UNIVERSITY
KOLHAPUR
Post Graduate SHIVAJI 2017 928 1600 58.00
(M.A.) UNIVERSITY
KOLHAPUR
Graduate (B.Ed.) SHIVAJI 2013 320 600 53.33
UNIVERSITY
KOLHAPUR

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Is the Candidate Domicile :- Yes
of Maharashtra

Language Known :-
Marathi Hindi English
Yes Yes Yes

Does candidate work in any :- No

State/Central Govt.
Department ?

Does Candidate have :- No

experience related to post /
any other experience ?

Typing/Shorthand :-
Qualification Name of the Course Certificate Marks Out of Grade Date of
Issued by Obtained Marks Passing
English 40 w.p.m. G.C.C. 76 100 A 07/11/2019

Details of Computer :-
Courses Name of Certificate Duration Marks Out of Grade Date of
the Course Issued by (months) Obtained Marks Passing
MSCIT MS-CIT 3 92 100 A 22/01/2008

Other technical :- Yes

qualification, if any Name of Course Certificate Duration
Issued by (In months)
TYPING MARATHI CGS 6
CONSTRUCTION MSBVEE 12
SUPERVISOR

Whether candidate has :- No

enrolled his name at
Employment Exchange?

Is there any criminal :- No

proceeding held/pending
against the candidate or is
he convicted by Criminal
Court or held guilty/facing
disciplinary enquiry?

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Fee Details :- Payment Gateway:- SBI Collect
Payment Type :- ePayment
SBCollect Ref. No.
:- DUI2813940
Date :- 24/12/2021
Amount :- Rs. 25

Signature of Applicant

FOR OFFICE USE

Affix your
passport size
photo here

Signature of Applicant

Printed on 24/12/2021 23:15:34

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 DECLARATION

1) I the applicant ATUL VILAS MANE

do hereby declare that I have not been arrested or convicted or held guilty or facing disciplinary enquiry for any offence
and that no case is pending against me in any Criminal Court for any offence.

2) I also affirm that all the details filled up in the application are true and correct as per my knowledge. If any
information is found to be false/incorrect, I will be liable to be disqualified from the process of selection and if
selected/appointed, my services would be liable to be terminated without any notice.

3) I have 1 (Number) living children as on today. Out of which No. 1 of children born after 28th March, 2005 is
03/12/2016, (mentioned dates of birth, if any).

4) I am aware that, if any total number of living children are more than two due to the children born after 28th March
2006, I am liable to be disqualified for the same post.

Place: KOLHAPUR

Date: 24/12/2021

ATUL VILAS MANE

Name and Signature of Applicant

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