S r n o Relationship (मा ता पि ता ,भा ई बहन, तिता, त्न, बच्चे Aadhar no Name of member Dependent (yes/no) Date of birth Marital status

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1. FULL name of employee & belt no ………………SURENDER………………………………………………..

2. Rank ………………ASI……………………………………………..

3. Posting …………………KOTWALI…………………………………………..

4. Aadhar No ………………455771043267………………………………………………..

5. Mob. No ………………………………………………………………..

6. Unique ID ………………………………………………………………..

7. Email ID ………………………………………………………………..
signature………………………….

8. Pan Card ………………………………………………………………..

9. Full Add. Pin Code ………………………………………………………………..

10. Marital status (with date ) ………………………………………………………………..


Thumb……………………………

11. Name Of Nominee ………………………………………………………………..

12. Height ……..ft…….inch, Blood G…….,Weight……….,Eye Sight……….,Eye color…………,Identification


Mark………………………………………………………

Actual Employee Category………………………………………..Recruited on Category…………………………………………

S Relationship(मा Aadhar no Name of member Dependent Date of qualification Marital status


r (yes/no) birth
ता पिता,भाई
n बहन,पति,पत्नी,
o
बच्चे
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