Pchedule-Lil-Form No.88 ATTESTATION FORM fl. Name in full (in block Capitals) with ] ‘Surname Namal 7 aliases, if any (Please indicate if you | ee eae | have added or dropped at any stage, a _ See any part of your name or surname) Present address in full (Ke, Village, Thana, District or House ‘Number, Lane/Street and Road), (2) Home address in full (ie. Village, : Thana and District or House Number Lane/Street and Road), (©) Ioriginally a resident of Pakistan, the address in that Dominion and the date of migration to Indian Union. [Particulars of places where you have resided for more than one year during the preceding five years, From To Residential addresses in full (ie. ] Village, Thana and District or House | Number, Lane/Street and Road) i 5-(a) Father's name in full with aliases, ifany j@ | (0) Present postal address(if dead, give last address) | » (©) Permanent home address, o (@) Profession, - (6) Ifin service, give designation and official address ie 6-i) Nationality of- | | (a)Father @) (b) Mother (0) (cHusband ic) (a) Wite (d) ii) Place of bicth of (a) Husband (a) (b) Wite (0) || 7G) Exact date of birch | (b) Present age | [c} Age at Matriculation 8.(a) Place of birth , District and State in which it is situated (b)Diserict and State to which you belong, @) (o) id fa) (0) 9,(a)State your religion (b) Are you a member of a Scheduled Caste, Scheduled | Tribe? Answer 'Yes' or ‘No’ and ifthe answer is "Yes" state the name thereof (a) (b) 10. Educational qualification showing place of education with years in Schools and Collages since 15 ear of age. Name of School/College with full address Date of entering Date ofleaving | Examination passed | 111 you have at any time been employed ave detals | Designation of post held or description of work Period Full address of the Office, firm of institution [12.Hlave you ever been convicted by a court of any offence? Ifthe answer is “Yes the full particulars-or the convictions and the sentences should be given 13, Names of two responsible persons of your locality or two references to whom you are known. a i) I certify that the foregoing information is correct and complete to the best of my knowledge and belief. Lam not aware of any circumstances which might impair my fitness for employment under Government. Place Date: Signature of Candidate.| (Certificate to be signed by a Gazetted Officer or Member of Legislature or other author ity | prescribed by the Appointing Authority) Certified that 1 have known Sri/Smé, Son/daughter of Sri for the last _ years —— Months and that to the best of my knowledge and belief the particulars furnished by him/her are correct. Signature, eo Designation or Status and address Pla Date:-