APA REGISTRATION FORM - WIDOW / WIDOW WARD(JCO)

(USE BLOCK CAPITALS ONLY)
WIDOW   WIDOW WARD
Temporary Registration No with Date :   ___________________________________
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APA Registration Number with date
(will be filled by APA) :  ___________________________________________
DETAILS OF DECEASED ARMY PERSONAL( HUSBAND / WIFE / FATHER / MOTHER ) :
1.   Personal No:    JC ___________________________________
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2.   Rank :    ____________________    
3.   First Name:    _______________________________          Middle Name :   _____________________________________  
      Last Name / Surname:   _________________________________________       Decoration, if any : ___________________
4.  Arms/Service :    _____________________________
    Day   Month Year     Day   Month Year
5.  Date of Enrolment :
   
   
       
6.    Date of Death :
   
   
       
7.    Death Occurred in :             ACTIVE SERVICE / PEACE / AFTER RETIREMENT/ WAR
8.  Cause of Death :    ___________________________________________________________________________________
DETAILS OF WIDOW / WIDOW WARD
9.  First Name of Applicant : ________________________________________________________________
      Middle Name of Applicant : ________________________________________________________________
      Last Name/Surname of Applicant : ________________________________________________________________
10.  Date of Birth
      Day      Month         Year
:
   
   
       
11.  Date of Marriage
      Day      Month         Year
:
   
   
       
12.  Whether SC/ST/OBC/Gen : ________________________________________________________________
13.   Academic Qualification : ________________________________________________________________
14.   Professional Qualifaction : ________________________________________________________________
15.   Work Experience (if any) : ________________________________________________________________
16.   Job Preference
         (select maximum five Jobs titles) : 		: 1. __________________ 2. ____________________ 3. ___________________
  4.__________________ 5. ___________________  
17.   Place Preference
        (select maximum five stations) : 		: 1. __________________ 2. ____________________ 3. ___________________
  4.__________________ 5. ___________________  
18.  Salary Expectation (Salary range ) :            From : ____________________ pm             To ______________________ pm
  Permanent Address Present Contact Address
19.  Address : ____________________________________ ____________________________________
20.  State : ____________________________________ ____________________________________
21.  District : ____________________________________ ____________________________________
22.  Town / City : ____________________________________ ____________________________________
23.   Pin Code : ____________________________________ ____________________________________
24.   Telephone No. with :
        STD Code 		____________________________________ ____________________________________
25.   Mobile No : __________________________________________________________________________
26.   E-mail ID : __________________________________________________________________________
27.   Passport Details, if any : (a) Passport Number : __________________ (b) Valid upto : ________________________
28.   Registration No of Zila Sainik Welfare Office , if any : ______________________________
29.   Registration No of Employment Exchange, if any : ________________________________
Date       : (Signature of Applicant)