Roll No..........................

(to be filled by officials)

APPLICATION FORM
POST APPLIED FOR: Affix recent
(please tick only one post) passport size
SURVEYOR photograph
LDC(OA-CUM COMPUTER OPERATOR) with self-
DRIVER attestation
KHALASI
PEON

(Read instructions carefully before filling up the form)

1. Name of applicant: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Father’s/Husband’s name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Sex (Male/Female): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Date of Birth (DD/MM/YYYY):.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Age as on 1st January, 2017 : Years . . . . . . . Months . . . . . . . . Days . . . . . . . . . . .

6. Present address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

District, P.O. & P.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contact No. . . . . . . . . . . . . . . . . . . . . .Email ID. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Permanent Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

District, P.O. & P.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Mother Tongue:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Whether Un-reserved/ST/SC/OBC (Meitei/Meitei Pangal/Others): . . . . . . . . . . (Please

tick in the relevant box below and enclose copy of self-attested certificate)

OBC(Meitei OBC
Un-reserved ST SC OBC(Meitei)
Pangal) (Other)

Contd… 2
 2
10. Documents enclosed:
Sl. No. Details of documents enclosed Tick if enclosed
1. Class-X certificate

2. Class XII certificate

3. Degree certificate

4. Surveyor certificate

5. Computer course Certificate (CCC)

6. ST/SC/OBC Certificate

7. Up to date valid Driving Licence

8. Employment Exchange registration

number

9. Employment Exchange sponsoring serial

number

11. I,.....................................................................................................Son/Daughter/Wife
of Shri/Smt .......................................................................................................hereby
declare that the information given above and in the enclosed documents are true to
the best of my knowledge and belief and nothing has been concealed therein. I am
aware of the fact that if the information given by me is proved false/not true, I will have
to face the criminal proceedings as per provision of section 177,193,197,198,199 and
200 of Indian Penal code and any other suitable provisions of the Law. Also, all the
benefits availed by me shall be summarily withdrawn and my application shall liable
for disqualification.

Date:
Place:

Signature of Applicant
 Roll No. ………………………
(to be filled by officials)
ADMIT CARD
SURVEYOR Affix recent
LDC(OA-CUM COMPUTER OPERATOR) passport size
DRIVER photograph
KHALASI with self-
PEON attestation.
(To be filled up by Candidate)
Name of the Candidate:…………………………………………………………………………..
Father’s/Husband’s Name:…………………………………………………………..…………..
Address:…………………………………………………………………………………………..
Whether: UR / ST / SC / OBC(M) / OBC(MP) / OBC(Others)

Signature of Applicant
Signature of the issuing Authority

Roll No.………………………
(to be filled by officials)
ADMIT CARD
SURVEYOR Affix recent
passport size
LDC(OA-CUM COMPUTER OPERATOR)
photograph
DRIVER with self-
KHALASI attestation.
PEON
(To be filled up by Candidate)

Name of the Candidate:………………………………………………………………………….

Father’s/Husband’s Name:………………………………………………………….…………...

Address:…………………………………………………………………………………………..

Whether UR / ST / SC / OBC(M) / OBC(MP) / OBC(Others)

Signature of Applicant
Signature of the issuing Authority
 INSTRUCTIONS FOR FILLING UP OF APPLICATION FORMS
1. Please fill the form in legible Capital letter so as to avoid errors in your application
processing. Please do not overwrite. Correction should be made by cancelling and
rewriting and such correction should be countersigned by the applicant.

2. Applications incomplete in any respect and /or not accompanied by required

documents are liable to be rejected.

3. The photograph should be pasted and not stapled or clipped to the form. Self-
attestation of the photograph should be such that half the signature on the photo
and on the application forms.

4. Name of the applicant at Sl No. 1 of the application form should be written in FULL
and BLOCK letters including surname as appeared in Matriculation Certificate.

5. Write present and permanent postal address in FULL at Sl No. 6 & 7, including
house number, street name, area name, village, circle and district with PIN code &
contact no. for future correspondence.

6. All applicants should indicate their social categories at Sl. No. 9 (whether belonging
to Unreserved/OBC/ST/SC) by putting tick (√) in the space/box provided. If any
applicant fails to tick mark, or fails to enclose self-attested photocopy of reservation
certificate, he/she will be treated as Un-reserved. No further claim will be
entertained after the last Date of submission of application form. Applicants
belonging to OBC categories should enclose certificates which are issued on or
after 01-04-2016.

7. Copy of the Exchange Card showing that his/her name has been sponsored for
therelevant post should be enclosed.