PRO-12310077629 GOVERNMENT OF ANDHRA PRADESH PROHIBITION AND EXCISE DEPARTMENT APPLICATION FOR THE POST OF PROHIBITION & EXCISE

CONSTABLE RECRUITMENT 2012 1. 2. 3. 5. 7. 8. 9. 10. 11. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. Candidate Id : 6000077629 Name : MD KHAJA MAZHERODDIN Post Applying District: NALGONDA Native District : NALGONDA 4. Native Mandal : NALGONDA Native Village : NALGONDA (URBAN) 6. Gender: Male Father/Husband name : MOHAMMED NIZAMODDIN Date Of Birth (DD/MM/YYYY): 10/2/1990 Address : 5-11-410/1,HYDERKHANGUDA,NALGONDA Pincode : 508001 Community : OC e-Mail : md.khaja.mazharuddin@gmail.com 12. Mobile: 9553341883 Whether Ex-Service Man : No Do you belong to Andhra Pradesh State : Yes Whether possess N.C.C Certificate : No Identification Marks : 1.A MOLE ON THE LEFT TEMPLE, 2 .A MOLE ON THE FOREHEAD Qualification Details Do you have requisite Educational Qualification (SSC/10th class or Equivalent Qualification) : Yes Do you have the Minimum Physical Measurements as per Notification : Yes Have you appeared for the interview during 1994 recruitment : No Are you an applicant covered by WP No.s 23152, 23931, 23932 of 2010 of AP High Court(if yes evidence should be furnished to that effect on notice) : No Language chosen to write the written examination : Telugu Do you claim meritorious sportsman quota: No Type of Study: Regular Do you claim local status with respect to the above Mentioned district or Applying in open(non-local) Category:No
4th class
Nalgonda

5th class
Nalgonda

6th class
Nalgonda

26. Districts where studied 7th class

Nalgonda

8th class
Nalgonda

9th class
Nalgonda

10th class
Nalgonda

27. Payment Details

Fee Amount
300 Declaration of the Candidate
I hereby declare that I have read the provisions in the rules and instructions issued in the notification of the Prohibition & Excise Constable Recruitment 2012 carefully and hereby undertake to abide by them. I further declare that I have not been debarred from appearing in any examination. I declare that I fulfill all the conditions of eligibility regarding age limits, educational qualification etc prescribed for admission to the examination. I declare that I am fully fit to compete in the PQT, PET and other physical tests and my fitness is certified by the medical practitioner and as I applied for the post of Prohibition & Excise Constable after going through about the physical requirement and other qualification and read the eligibility criteria, I further declare that I have got myself medically checked up by a certified doctor in this regard, and that if any untoward incident occurs during the course of PQT PET or any tests I shall be solely responsible and I declare that I am participating in all the above tests on my own accord and on my own, without any coercion from anybody. I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found to be false or incorrect or incomplete and that I have suppressed any information or that I do not satisfy the eligibility criteria, my candidature for the selection is liable to be rejected or cancelled and even after appointment my services are liable to be terminated without any notice. I am willing to serve the department and will serve anywhere in the state on duty if selected. Note:1.If any incorrect false/bogus or unconnected information is furnished, the candidature of the applicant, whenever instances come to the knowledge and the selection process will lead to disqualification of the candidate from the selection process and he/she will not be allowed to appear for further examination liable for Criminal Action, and also liable for punishment u/s 40(a) of AP Excise Act 1968 with imprisonment upto three years . Further if such instances go undetected during the current selection process but are detected in subsequent years, such disqualification will take place with retrospective effect. 2.The candidates shall bring original certificates along with one set of attested Photo stat copy for verification at the time of PET. Those who have not furnished the original along with one set of Photo stat copy for verification will not be allowed for participation in PET.

Journal Number
ENGMP0000213

Payment Date
23/10/2012

Sd/MD KHAJA MAZHERODDIN Download Hall Ticket for PQT from 11 AM on 20th Nov,2012 onwards at http://cpe.cgg.gov.in Generated for P & E Recruitment Processing: http://cpe.cgg.gov.in POWERED BY Governance Centre for Good