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Zilla Panchayath, GULBARGARural Development and Panchayath Raj
Department
Government of Karnataka
Acknowledgement Slip
Reference No 290438
Post applied for PANCHAYATH DEVELOPMENT OFFICER
District opted forappointment
GULBARGA
Place of Examination GULBARGA
Full Name( as inSSLC/10th Cert)
SHRISHAIL MATH
Mother's Name KALAVATI
Father's Name SIDRAMAYYA MATH
Gender Male
Date of Birth 01/06/1973
Applied Category 3B
Do you come underthese groups? Rural KMS
Are you in Govt.Service?
No
Do you claim agerelaxation?
Not Applicable
Are you a Graduate? Yes
Address forcommunication
C S BIDARIMATH, VIDYACHETAN , RAMDEVGALLI,JAMKHANDI
District BAGALKOTE PIN 587301
Email address [email protected]
Landline Phone No
Mobile Phone No 9986158495
Medium of writingtest
Kannada
I hereby declare that all contents made in this applicationare
true, complete and correct to the best of my knowledge and belief.
I have
read the rules and understand that in the event of any
information being found
false or ineligibility being detected before or after the
selection ,action can be
taken against me by the Government under rule 20 of Karnataka
Civil
Services(General Recruitment) rules 1977 as amended from time to
time.
I have read the rules and instructions carefully and
hereby undertake to abide by them. I further declare that, I
fulfill all the
eligibility conditions regarding age, education qualifications,
reservations etc.,
wherever applicable,prescribed for the post.
Place :BAGALKOTE
Date :06/08/2009 Signature of the Candidate
Slip
http://www.recruitment.kar.nic.in/rdpr/AckSlip.aspx?RefNo=290
10/7/2009
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LAST DATE OF CHALLAN PAYMENT AT BANK: 11.08.2009
Challan ChallanZilla Panchayath, GULBARGA
Rural Development & Panchayat RajDept.
Government Of Karnataka
Candidate Copy
bank use only
Bank andBranch Name
Bank Journal No
Bank JournalDate
Post Applied For PANCHAYATH DEVELOPMENT OFFICER
District opted forappointment
GULBARGA
Ref No 290438
Name SHRISHAIL MATH
AddressC S BIDARIMATH, VIDYACHETAN ,RAMDEV
GALLI,JAMKHANDI,BAGALKOTE
Paid into the Credit of Secretary RDPR
A/C No 64044930154 , State Bank of Mysore , VidhanaSoudha ,
B'lore
Sl No Particulars Amount
1 Application Fee 500.00
Total 500.00
Amount in Words: Five hundred only
Signature of Remitter/Applicant
Received the above amount in Rs(in words) Five hundred only
Date :Signature of Receiving
authority
Accepted at all the Branches of SBM. (In case of nonavailability
of SBM then SBI or SBH)
No bank charges to be collected from theremitter/applicant
Zilla Panchayath, GULBARGA
Rural Development & Panchayat RajDept.
Government Of Karnataka
Bank Copy
bank use only
Bank andBranch Name
Bank Journal No
Bank JournalDate
Post Applied For PANCHAYATH DEVELOPMENT OFFICER
District opted forappointment
GULBARGA
Ref No 290438
Name SHRISHAIL MATH
AddressC S BIDARIMATH, VIDYACHETAN ,RAMDEV
GALLI,JAMKHANDI,BAGALKOTE
Paid into the Credit of Secretary RDPR
A/C No 64044930154 , State Bank of Mysore , VidhanaSoudha,
B'lore
Sl NoParticulars Amount
1Application Fee 500.00
Total 500.00
Amount in Words: Five hundred only
Signature of Remitter/Applicant
Received the above amount in Rs(in words) Five hundred only
Date :Signature of Receiving
authority
Accepted at all the Branches of SBM. (In case of nonavailability
of SBM then SBI or SBH)
No bank charges to be collected from theremitter/applicant
Print Back
Slip
http://www.recruitment.kar.nic.in/rdpr/AckSlip.aspx?RefNo=290
10/7/2009
