Police Verification & Character Undertaking Bio-Data

Tenant & Domestic Staff

Standard character and tenant police verification undertaking draft with Thana jurisdiction, identification marks, and neighbor referees.

Verification Authority & Photos

Police Station (Thana Jurisdiction)

Passport Photograph

Individual's Particulars

Full Name

Alias (उर्फ)

Father's Name

Date of Birth

Identification Mark (Mole / Scar)

Mobile Number

Aadhaar (Masked)

Address Details

Permanent Address (with Native Thana)

Present Address in City

Period of Stay at Present Address

Employer / Landlord Details

Name

Phone Number

Premises / House Address

Local Referees

Referee 1

Referee 2

POLICE VERIFICATION & CHARACTER UNDERTAKING FORM

(चरित्र एवं पुलिस सत्यापन प्रपत्र)

Jurisdiction: Police Station Sector-20, Noida, Dist. Gautam Buddha Nagar

Affix Photo

1. Individual's Particulars

Full Name & Alias:RAMESH KUMAR (Alias: Ramu)

Father's Name:Shri Bhagwan Das

Date of Birth:12/04/1995

Identification Mark:Black mole on right side of neck

Mobile Number:98123 45678

Aadhaar (Masked):XXXX-XXXX-9012

Occupation / Trade:Domestic Cook & Driver

2. Addresses & Police Thana

Permanent Address:Vill: Chandpur, Thana: Bilsi, Dist: Badaun, Uttar Pradesh - 243633

Present Address:Quarter No. 4, Servant Block, Sector-26, Noida, UP - 201301

Stay at Present Address:2 Years 6 Months

3. Employer / Landlord Information

Employer / Landlord:Shri Alok Singhal (Ph: 98100 99887)

Premises Address:Plot No. B-48, Sector-26, Noida, Uttar Pradesh - 201301

4. Local Referees / Guarantors (स्थानीय गवाह)

• Shri Mahender Pal (Mob: 98711 22334), R/o Sector-26 Noida

• Shri Dinesh Kumar (Mob: 99100 44556), R/o Vill Chandpur Badaun

I hereby solemnly declare that all statements made above are true to the best of my knowledge and belief. I have not concealed any material facts. I am aware that furnishing false or misleading information to public authorities constitutes a cognizable offence under Section 177 & 182 of the Indian Penal Code.

(Signature / Thumb of Individual)

(Signature of Employer / Landlord)