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APPLICATION FORM FOR SANCTION OF NEW MEESEVA

CENTRE BHADRADRI KOTHAGUDEM DISTRICT

Application No.:
(To be filled by the Tahsildar’s Authorities only.) Photo of the
Applicant

1. Place of the MeeSeva Center Applied for :

2. Name of the Applicant with Surname :

3. Father’s Name :

4. Mobile No. & email :

5. Aadhaar No :

6. Date of Birth (age in years) :


(Between 18- 35yrs.)

7. Caste :

8. Residential Address as per POA :

9. Educational Qualifications & Experience :


(Graduation or Above)

10. Technical Qualifications :


(Decent Computer Knowledge)

11. Willingness to invest in the


Infrastructure (Yes/No) :

I hereby declare that all the above details furnished in the application
are true and complete to best of my knowledge and belief. I understand that if
any of the information given by me in this application is anyway false or
incorrect will be rejected.

Date: Signature of the Applicant

Note:The applicant to submit Gazetted attested Xerox copies of the his/her


SSC Memo, Aadhaar Card, Caste, Residence certificates, Education
qualifications along with the application form compulsory.

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