Address Verification Form

Date of Visit: 10.06.2024 Time of Visit: 5.22 PM Executive Name:

GOMATHI S
Candidate Name

NO:149,12TH STREET, ROTARI NAGAR, TRIPLICANE, CHENNAI-600005

Address

Anburani
Name of Person Met Person Met Contact No: 8838285087

□ Father  Mother □ Sister  Wife  Son /Daughter  Brother

Relationship with
Candidate □ Self □ Other Specify:
 Relative

Period of Stay From 2021 to Till date

□ Self Owned □ Owned By Parent  Owned By Relative

Ownership Residence
□ Rented □ Company Accommodation  Paying Guest
□ Independent □ Flat  Chawl
Type Residence House
□ Row House  Temporary Shed
□ Bungalow
` Shanthi
Neighbour Check (I)
Name & Address

Neighbour Check (II)

Name & Address

Security Confirmation Name on Society Board Easy of Locating

□ Yes  No □ Yes  No □ Easy  Difficult  Untraceable

Landmark: Near Rahamad

Verifier’s Name: Vignesh