APPLICATION FOR THE POST OF GDS BRANCH POSTMASTER, VARAGUR BO A/W NADUKAVERI SO 613101.

1. Name of the Candidate(In Capital) 2. Fathers/Husbands Name 3. Date Of Birth (In Christian Era) (Documentary proof to be attached) 4. Permanent Residential Address : : : :

5. Present Address

6. Name of Police Station 7. Community (viz., SC/ST/OBC/OC) In Case of SC/ST/OBC certificate of proof from revenue authorities to be attached in the prescribed format. 8. Educational qualifications (Copy of SSLC Mark List should be attached) 8.a. SSLC Marks obtained 9. Occupation at present 10. Annual Income from a. Immovable properties b. Any other Sources 11. Are you a member of political party 12.Are you functioning as agent of LIC or any Other institutions

: :

: : :

: Rs. : Rs. :

I,______________________________Son/Daughter/Wife of ______________________________ do hereby solemnly declare that the particulars furnished above are correct to the best of my knowledge and I hold myself responsible for any incorrect particulars furnished above, for any action by the Department. I also declare that I am not functioning as LIC Agent or SAS Agent or agent to any other institution. Station: Date: List of documents enclosed:1. 2. 3. 4. 5.

Signature of the Candidate.