OFFICE OF THE DY. COMMISSIONER OF POLICE SPECIAL BRANCH (1), C.LD., MUMBAT Personal Particulars Form (2) Name in full (IN BLOCK LETTER ) with SURNAME aliases if any sie art cers oirsara) 2) Present Address in full svar atgeh se 3) Home Address in full (i.e. Village, Thana, Taluka/ Tahsil and District or House No. Lane/StreevRoad and town alongwith pin code.) rarer pt wom reise, ait, a, Facet sere a aeeti/oer/ren ane a as a) From 7 (4) Particulars of the places (with period of (i) residence) where you have resided during preveding years since birth arf ser em ore onien pH Tz Gi) rere ATT ait) (5) Information Name Occupation with address safe a Sra To @) Father ee Gi) Mother ome ii) Husband/ Wife wt Tot (iv) Brother () Sister (©) Date of birth and present age ee aiken a AY (Place of birth (full address ) SM Gh Ta) (8) Education qualification showing places of (i) Gi) education with year in school/colleges. Date of Date of centering leaving eran ates ae ar Gv) Name and address of school/college. “ara APTA TT 0 Gi) Git) (i) (GCP, K 1980 (50,000-2.06) NAME ae Present address ar Ta Git) Examination passed tore ar et0) (10) ay 2) 3) «aay Place Date fee Note 2 Have you ever been arrested/prosecuted/ detained! fined/convicted? It so, give particulars of the ease sar at sey gre ent ezor IST Have you ever taken active part in politics ? If so, give particulars. Saray ih Tora fa I ATT I ST? SN AEM TE, Present occupation/service with all particulars Rearen strees Serer a eae oP at Reasoning for obtaining character and antecedent certificate and to whom its required. sist Tecra aya eat rears paneer vafest one a arora Paro? Identification Mark ira re Names, addresses and signatures of the two (I) responsible persons of your locality to whom you are known certify that the forgoing information is correct and complete to the best of my knowledge and belief hore Soon mete en es aR eA ee AY MTT eerge Pree SES aT SE. Signature of the applicant spf ere Applicant should attach the following alongwith the application :~ (1) A demand draft of Rs. 100 in the name of Commissioner of Police, Brihan Mumbai (2). Two passport size photographs, (3)_ Xerox copy of ration card showing applicant's name and address, (4). Xerox copy of the schoo! leaving certificate. (5)__Xerox copy of the passport (it any), (6) Demanding letter from Company/Institution Ware ara, Ta a a coo Rua aT fete gE (wari aga arr wet (3) as Ashen stole ore at we SAGO Sele co) ere Arsearea areca See rr (oer seems, cae scat arr eh Sees or, (@) Sen sien att nie werent amir