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Note : Please Download the Antecedent Verification Form and submit 2 copie's of the
same duly signed by you at the time of Verification

Antecedent Form

Personal Details

VSWS HallTicket Number 191209005948

Applicant Name LINGAMDINNE SIREESHA

Panchayat Secretary (Grade-VI) Digital

Post Applied
Assistant

Date Of Birth of Applicant 10/06/1997

Mobile 7013101605

Religion HINDU

Community OC

Community Sub Caste KAPU

Place Of Birth MYDUKUR

District To Which Belong KADAPA

Martial Status UNMARRIED

Present District KADAPA

7/508,VENKATESWARA
Present Address
NAGAR,PRODDATUR,Proddatur,516360

Permanent District KADAPA

5/41 A,BADVEL
Permanent Address
ROAD,MYDUKUR,Mydukur,516172
 PRECEEDING RESIDENTIAL DETAILS

From To
Sl.No Residential Address Police Station & District
Month/Year Month/Year

7/508, VENKATESWARA
THREE TOWN POLICE
1 11/2019 11/2019 NAGAR,SVSM ROAD,
STATION,PRODDATUR,KADAPA
PRODDATUR,KADAPA

7/508, VENKATESWARA
THREE TOWN POLICE
2 11/2018 11/2019 NAGAR,SVSM ROAD,
STATION,PRODDATUR,KADAPA
PRODDATUR,KADAPA

7/508, VENKATESWARA
THREE TOWN POLICE
3 11/2017 11/2019 NAGAR,SVSM ROAD,
STATION,PRODDATUR,KADAPA
PRODDATUR,KADAPA

7/508, VENKATESWARA
THREE TOWN POLICE
4 11/2016 11/2019 NAGAR,SVSM ROAD,
STATION,PRODDATUR,KADAPA
PRODDATUR,KADAPA

7/508, VENKATESWARA
THREE TOWN POLICE
5 11/2015 11/2019 NAGAR,SVSM ROAD,
STATION,PRODDATUR,KADAPA
PRODDATUR,KADAPA

Father Details

Father Name LINGAMDINNE VENKATA SUBBAREDDY

Profession/Job No

Postal District KADAPA

Postal Address 7/508,VENKATESWARA NAGAR,PRODDATUR,Proddatur,516360

Permanent District KADAPA

Permanent Address 5/41 A,OBUL REDDY NAGAR,MYDUKUR,Mydukur,516172

EDUCATION QUALIFICATION DETAILS

Examination
Name Of
Entering Leaving RegNo & Police Station &
Course School/College
Date Date Passed District
Address
Details

SANTINIKETAN HIGH
SSC/Matriculation 06/2011 04/2012 1222113672 MYDUKUR,KADAPA
SCHOOL,MYDUKUR

NRI
Intermediate/Diploma 06/2012 04/2014 1409211734 TIRUPATI, CHITTOOR
ACADEMY,TIRUPATI

Y.S.R ENGINEERING THREE TOWN

Graduation/Professional
COLLEGE OF YVU, 09/2014 04/2018 1011403019 POLICE STATION
Course
PRODDATUR,KADAPA PRODDATUR,KADAPA

Post Graduation --- --- --- --- ---

Any other Qualification --- --- --- --- ---

 Case Details

Is Arreted By Police.convicted by Court Of

No
Law Under any state/central Laws

Have you ever been arrested No

Have you ever been prosecuted No

Have you ever been kept under detention No

Have you ever been bound down No

Have you ever been fined by a Court of Law No

Have you ever been convicted by a court of

No
Law

Have you ever been debarred from any

examination or rusticated by
No
any university or any other educational
authority/institution

Have you ever been debarred /disqualified

by any Public Service
Commission/Staff Selection No
Commission/or any other recruitment
board for any of its examination/selection

Is any case pending against you in any

court of law at No
the time of filling up this Antecedents form

Is any case pending against you in any

University or other educational
No
authority/institution/ at the time of filling of
this Antecedents Form?

Whether discharged/expelled/with drawn

from any training/institution under No
the Government or otherwise?

RESPONSIBLE PERSON DETAILS

First Preference Second Preference

Name in Full Sur Name KALLUTLA KONDAREDDY BODELA SIVA SANKAR REDDY

Given Name If Any -- --

Fathers Name KALLUTLA ANJENEYA REDDY BODELA NARAYANA REDDY

House/Apart/Flat No 7/507 7/512

Street and Road VENKATESWARA NAGAR VENKATESWARA NAGAR

Village PRODDATUR PRODDATUR

Mandal/Taluk Proddatur Proddatur

Town/City Election Ward No. 7 Election Ward No. 7

District KADAPA KADAPA

Pin Code 516360 516360

Urban/Rural URBAN URBAN

DECLARATION DETAILS
1. I hereby declare that the statements made In this form are true to the best of my knowledge
and belief.
2. I am married / unmarried and have only one wife living ( delete which Is not applicable).
3. I am fully aware that furnishing of false Information or suppression of any factual Information
in the Antecedents Form would be a disqualfication and is likely to render me unfit for
employment under the Government.
4. I am also fully aware that If It comes to notice at any time during my service that false
Information has been furnished or that there has been suppression of factual Information in the
Antecedents Form, my services would be liable to be terminated solely on this ground.
Date Signature of the Candidate
Place (Full Name: )

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