ANNEXURE -I Candidatesshould submittheirapplication on Plain whitepaperin thefol owingproforma PostApplied for : Zone / District : ATTESTED PHOTO 1.NameinBlockletters : 2.Father's/Husband'sName : 3.FullPostaladdresswith Pin Code : 4.Sex : 5.DateofBirth : 6.EducationalQualifications : 7.DateofPassingM.B.B.S. / B.D.S. Exam ination : 8.Additionalqualifications,ifany : 9.SocialStatus : 10.LocalDistrict / Zone : 11.Identification Marks : (asmentioned in S.S.C.Certificate) UNDER TAKING : I do hereby declare that all the above information furnished by me is true and correct. I further declare that if any thing found incorrect, I shall be liable for termination from service with immediate effect without any notice. SIGNATURE OF THE CANDIDATE
