Department of Revenue and Disaster management APPLICATION FOR THE POST OF DEPUTY TAHSILDAR Affix Passport size photograph duly attested by a Gazetted Officer 1. Name of the Candidate (Capital letters) : 2. Father's / Husband's name : 3. Nationality : 4. Address for communication (in block letters with pin code) : 5. Date of Birth 5.1 Age as on 31.07.2010 (completed years & months) : : 6. Sex : Male / Female 7. Employment Exchange of U.T. of Puducherry 7.1 Registration Number } 7.2 Date of Registration } if available : : : 8. Community (SC /BT/ OBC /MBC/ GEN) (Attested copy of the certificate should be Enclosed) : 9. Category (XSM / MSP) ((i) For XSM, attested copy of Discharge Certificate should be enclosed. (ii) For MSP, attested copy of certificate along with Form-I to V, wherever necessary, should be enclosed.) : 10. Whether Native of U.T. of Puducherry : (Attested copy of certificate should be enclosed) 11. Educational Qualifications : (Attested copy of certificate should be enclosed) 12. Details of Attested copies of certificates : 1. Birth Certificate enclosed (Please tick / ) 2. Educational qualification 3. Nativity Certificate 4. Community Certificate 5. Employment registration card 6. Category certificate (XSM/ MSP) 13. Any other information if any : I hereby certify that the information furnished above by me is true and I understand that my application is liable for rejection at any stage if any information given is found to be false. I undertake to furnish the originals of all certificates for verification as and when called for. Date: Signature of the Candidate Place:
