Mira-Bhayander-Vasai-Virar
Application cum Personal Particulars Form for Character & Antecedents Verification
पतत : वतरषष पपललस तनरलकक , Pelhar P. Station पपललस षठणण.
खठललल नममद ममददठदवर अररदठर गगड.
Mira-Bhayander-Vasai-Virarकदपनलचण Mira-Bhayander-Vasai-Virarनठव Rashmi Enterprises यठदचल चगकशल
करन ममळ कठगदपतठदसह अहवठल पडतठळणल शठखठ, तव. शठखठ,Mira-Bhayander-Vasai-Virar यणथण सठदर करठवठ.
१) अररदठर तदलणलयठ पततयठवर कणवहठपठसमन रठहत आहण ?
२) अररदठरठतवरद आपलण पपतलस षठणयठचण अतभलणखठवर गमनहण , आकणपठहर ननदल आहण त कठ?
असलयठस गमनहठ ननद क., कलम,कपरर ,कपरर कणस क. व गमननठचल सदससथतल कळवठवल.
रठवक क. /तवशठ/पडतठळणल/तद. / /२० पपउप आयमकत, तव.शठ.Mira-Bhayander-Vasai-Virar
Applicant's Name GAUD SANTOSHKUMAR RAMBALI Application ID MBVV08251000492
ID Name Others ID No 743893612043
Aadhar Card No. Mobile No. 9369834398
Email ID
Present Residential Address
E/10 Aai Jivdani Chawl No 4 Valai Pada Road santosh bhuvan Near Narendra Nagar ApartmentNallasopara East
Vasai-Virar City (M Corp) Vasai Palghar MAHARASHTRA-401209
Previous Address
Do you need to verify your previous address
Address
Native/ Permanent Address
E/10 Aai Jivdani Chawl No 4 Valai Pada Road santosh bhuvan Near Narendra Nagar Apartment Nallasopara East
Vasai-Virar City (M Corp) Vasai Palghar MAHARASHTRA 401209
Company Name and Address where NOC/ Certificate is submitted
Designation Operater Company Rashmi Enterprises
Address Shop No 4 Jay Vijay Apartment Opp Talathi office Near Railway Station Nallasopara East Vasai-Virar City
(M Corp) Vasai Palghar MAHARASHTRA 401209
Particulars of places where the Applicant has resides during last 10 years
Sr. No Address From To Pincode
1 E/10 Aai jivdani chawl no 4 valai pada road santosh bhuvan nallasopara 05/2014 08/2025 401209
east
Present Occupation / Service ( Joining date, Post, Office Address & Telephone)
03/08/2025
Visible Identification Mark
Have you been Arrested / Prosecuted? If yes, give case details ( C.R. No. & [Link] )
No
Have you been Active in Politics? If yes, give details of the party / organisation.
No
Is there any Criminal Offence registered against you?
No
Name, Address & Signature of two persons in your locality who knows you.
Name & Address Mobile No.
vijay shankar tailor satyam complex co op hsg ltd nallasopara west 7276785302
ronak rathod bolinj naka virar west 7757841992
I hereby solemnly state that information provided above by me is true and correct.
Place nallasopara
Date 03/08/2025 Applicant's Signature
EMAIL ID
ANNYGAUD@[Link]
MOBILE NO
8108138850
