4/2/2018 Bombay High Court - Recruitment

Distict Court Recruitment For the Post of Class III and Class IV Employees

ACKNOWLEDGMENT RECEIPT

Registration - ID DCR144323

Name AKSHAY SURESH THOTE

Gender Male

Category Schedule Castes (CHAMBHAR)

Date of Birth 24/05/1996

Address 42 CIVIL LINE BEHIND REGAL COMPUTER WASHIM

District WASHIM

Pincode 444505

Contact Details Mob. No.:7875381731

I the applicant do hereby affirm that all the details filled up in the application are true and correct as per my knowledge. If
any information is found to be false/incorrect, I will be liable to be disqualified from the process of selection and if
selected/appointed, my services would be liable to be terminated without any notice. I further declare that there is no criminal
prosecution pending against me or I am not convicted by a Criminal Court or held guilty or facing disciplinary enquiry.

I am aware that, if any total number of living children are more than two due to the children born after 28th March 2005, I

am liable to be disqualified from the same post.

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