Specimen Form en
Specimen Form en
Specimen Form en
Private Official
04. (a) Date of Birth: Year : ................ Month : .............. Date : ...............
(Copy of the Birth Certificate should be attached)
(b) Age at closing date of applications: Years: ........ Months: ........ Days: ........
13. Have you been convicted for a criminal offence by a Court of Law? ( Yes / No)
If yes, give details:
.............................................................................................................................................
14. Have you served under the Government? ( Yes / No )
If yes, give details:
.............................................................................................................................................
I do hereby certify that all the particulars furnished by me in this application are true and
correct. I am also aware that, I am liable to be disqualified for serving in the Committees if
any particulars contained herein are found to be false or incorrect before selection, or not to
be summoned to serve in Committees if such detection is made after selection.