TELANGANA STATE LEVEL POLICE RECRUITMENT BOARD

PRELIMINARY APPLICATION FORM - 2022

PART- I
Notification Rc No. 41 / Rect. / Admn-1 / 2022 dated 25-04-2022
Post/s Applied for SCT PC CIVIL AND / OR EQUIVALENT

Medium of Written Examination

(Except Technical Papers, which TELUGU Registration Number
will be in English only)

Name of the Candidate AMGOTH SRAVAN NAIK 71391588

Father's Name AMGOTH CHITTIBABU

Mother's Name AMGOTH SEVRI

Gender MALE Community ST

Date of Birth 08-04-1994 Age as on 01-07-2022 28 years 2 months 25 days

Aadhaar Number 684946335108 SSC Roll No 1030124462

amgothsravannaik@gmail.c
Mobile Number 9959559024 E-mail Id
om
Identification Mark 1 A MOLE ON THE NECK

Identification Mark 2

State (Local Candidature) TELANGANA

Local Candidature as per study from 1st Class to 7th Class
KOTHAGUDEM-BHADRADRI
(as per new Presidential Order,2018)
Educational Qualification as on 01-07-2022 INTERMEDIATE

District Preference for appearance in Tests / Exams - I KOTHAGUDEM-BHADRADRI

District Preference for appearance in Tests / Exams - II KHAMMAM

Note:

1. Candidate will be allotted any town in the Districts selected or any nearby District depending upon the
availability of accommodation for appearance in the Tests / Examinations.
2. In case Candidate submits application for SCT SI (Technical) / SCT PC (Technical), Candidate will be allotted to
any center in Hyderabad city or nearby.

Address for Communication

Name Amgoth sravan naik
C/o KOTHATHANDA
H. No. & Colony 7-13
Village / Town / City KOTHATHANDA PEGALLA PADU Mandal Tekulapalli
District Kothagudem-Bhadradri Pin Code 507123

DECLARATION

I hereby declare that I have read all the instructions mentioned in the Notification(s) carefully and I hereby undertake to
abide by them. I am responsible for the correctness of the above details filled in by me. I further declare that the information
furnished by me is true and correct to the best of my knowledge and is as per the Certificates / Relevant documents.

Signature

31/10/2022 10:23:07 Application Submission Date&Time: 17-05-2022 01:24:06 PM