ITA/E/95-95  SL.

APPLICATION FOR THE PERMANENT RESIDENTIAL CERTIFICATE  FROM THE DEPUTY COMMISSIONER :: PAPUM PARE DISTRICT, A.P. 

  1. Name of the applicant (In capital letter)  ...................................................................................

  2. Father's /Husband name                         ..................................................................................

  3. Name of person whom required             .................................................................................

  4. Permanents Address                               .................................................................................   

              Village                               ................................................................................................               

              Police Station                     ................................................................................................    

              District                                ...............................................................................................

              Present Address                      ..........................................................................................

              Village                                      ........................................................................                                      

          Police Station                           .......................................................................    

          District                                      .......................................................................

  1. Name of Guardian                     .........................................................................................  

  2. Relation with the Gurdian           .........................................................................................

  3. Present Occupation                    .........................................................................................

  4. Specified purpose for which the certificate is requiredwill be issued only in case of higher education or specific related.                                                    .................................................................

 

Signature of applicant.

Certificate that the above particulars furnished by the applicant corresct to the best of my knowledge and belief.

 

Recomendation of the concerned Administrative officer of the Area.

 

Verified by :

MP/MLA.

 

Seal.

*****