SARPANCH CHARACTER CERTIFICATE
1. This is to certify that, YASH RAMCHANDRA CHAVAN son of RAMCHANDRA GOVIND
CHAVAN is resident of Village BHOM (KHALCHIWADI) Post Office BHOM Tehsil
CHIPLUN District RATNAGIRI State MAHARASHTRA PIN 415628 and I know him since
last 03 years.
2. As per my information, he bears a good moral character.
Place : BHOM ----------------------------------------------
(Signature of the Village Sarpanch)
Date :
(Round Stamp)
POLICE CHARACTER CERTIFICATE
1. This is to certify that, YASH RAMCHANDRA CHAVAN son of RAMCHANDRA GOVIND
CHAVAN is resident of Village BHOM (KHALACHIWADI) Post Office BHOM Tehsil
CHIPLUN District RATNAGIRI State MAHARASHTRA PIN 415628 is residing at
mentioned address since last 02 years.
2. There is nothing criminally and politically adverse report against him as per police
record held with this office.
Place : CHIPLUN ---------------------------------------------
(Signature of the Police Authority)
Date :
(Round Stamp)
CHARACTER/ PRE -VERIFICATION CERTIFICATE
1. It is certified that RAHUL VILAS BAMANE son of VILAS BARKYA BAMANECaste
HINDU MARATHA resident of Village BHOM (BAMANEWADI) Post Office BHOM
Tehsil CHIPLUN District RATNAGIRI State MAHARASTRA PIN 415628
whose signature/thumb impression is appended below
is known to me for the past 03 years to the best of
my knowledge and belief :-
(a) He bears a good moral, character.
(b) He has not been convicted by any civil court.
(c) He has never been imprisoned.
(d) He has not been dismissed from any Government service.
(e) He has not been serving in the Army/Navy/Air Force/TA or Police.
2. It is further certified that he is not related to me.
------------------------------------
Signature /Left thumb impression
of prospective recruit
Place :BHOM -------------------------------------------------------
Date : (Signature of the Officer with his office seal)
Note :- To be signed by any of the following :-
(a) Sponsor or a respectable person of his native village.
(b) District/Police/ Revenue Official.
(c) Headmaster / Principal of a recognized School / College.
(d) Block Development Officer / Post Master / Panchayat Inspector / Village
Sarpanch / Pradhan.
(e) Armed Forces Commissioned Officer (Active List)
Signature of Two Witnesses
1. Name AMARNATH VISHWANATH NATE Address At/PostBHOM Signature
2. Name VINOD SHANTARAM CHAVAN Address At/Post BHOM Signature
Particulars of Family Members of Candidates: Name RAHUL VILAS BAMANE
Sr.No Relationship Name Date of Signature / Thumb
Birth Impression
1 FATHER VILAS BARKYA BAMANE 01/06/1960
2 SELF RAHUL VILAS BAMENE 11/08/1999
Note : Certificate for proof of date of birth of brothers to be submitted as under :-
10th class Pass certificate / School Leaving/ Bonafide / Birth Certificate / Aadhar
Card / Pan Card / Voter ID in Which name and date of birth of brother / sister clearly
mentioned.
Place : BHOM Signature of sarpanch/Pradhan
with his office seal
Date :
POSTAL ADDRESS PROOF
NAME : YASH RAMCHANDRA CHAVAN son of RAMCHANDRA GOVIND CHAVAN
ADDRESS : HOUSE NO -
VILLAGE - BHOM ( KHALCHIWADI )
POST OFFICE - BHOM
TALUKA - CHIPLUN
DISTRICT - RATNAGIRI
STATE - MAHARASHTRA
PIN - 415628
Place : BHOM Signature of Post Master with
office seal
Date :
(Round Stamp)
UNMARRIED CERTIFICATE
1. This is to certify that, YASH RAMCHANDRA CHAVAN son of RAMCHANDRA
GOVIND CHAVAN is resident of Village BHOM (KHALCHIWADI) Post Office BHOM
Tehsil CHIPLUN District RATNAGIRI State MAHARASHTRA PIN 415628
2. He is unmarried till date.
Place : BHOM --------------------------------------------------------------
(Signature of Village Sarpanch with his stamp/seal)
Date :
