Sunteți pe pagina 1din 2

Gurgaon Police

Information on Domestic Help/Tenant/Employee


Particulars of Employer//Landlord
1. Sector/Village/Colony/Society

Passport
Size
Photograph

2. Plot no./Flat No. /House No./Street


No./Police Station
3. Name & Fathers name of Employer/Landlord with Mobile No.
i) Name of the Landlord/Employer
ii) Fathers Name
iii) Contact No.

4.

Signature of the
Applicant

Particulars of Employee/Tenant/Domestic Help

Full Name

Phone No.

Alias
Father Name
Spouse Name

Occupation

Nationality

Age

Sex

Caste

5.

Permanent Address

House No.
Sector/Village/Locality
Police Station
District & State
Landline/ Mobile No.
Proof of Identity (Voter card/Driving License/Ration Card etc.)
Two References from
Native Place (Name,
Address & Ph. No.)

1.
2.

6.

Local (Current) Address

House No.
Sector/Village/Locality

Residing at current address since

Name of Landlord & Address

Police Station
Police Post

Mobile No.
Two Local References

1.

(Name, Address & Ph. No.)

2.

7. Nature of Employment

Place of Work

(Domestic Servant/Shop Employee/Industrial


Worker/Chowkidar/Dhobi/Tradesman/Craftsman
etc.)

8. Particulars of Previous Employment (in case of Employee)


Nature of Employment
Address
Particulars of Previous Employer (with mobile no.)

9. Particulars of Family members residing with the Tenant/Employee


Sr. No.

Name

Age

Sex

Relation

Occupation

Mobile no.

This is only Information Form. I am getting his/her Police


verification done separately by addressing the concerned jurisdiction SP (of permanent
address) in the prescribed Proforma.

Signed by

(Name)
Employers/Landlord.
Dated

S-ar putea să vă placă și