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Antecedent Form

Personal Details

VSWS HallTicket Number 190501001474

Applicant Name RAAMAANA UMA RAJASRI

If Check Candidate Name is misspell Yes

Candidate Name Changed -

Post Applied Panchayat Secretary (Grade-V)

Date Of Birth of Applicant 03/03/1990

Mobile 8660025381

Land Line Office -

Land Line Residence -

Religion HINDU

Community BC-B
Goud (Ediga) Gouda (Gamella) Kalalee, Goundla, Settibalija of
Community Sub Caste Vishaphapatnam, East Godavari, West Godavari and Krishna Districts
and Srisayana (Segidi)
Place Of Birth KOYYALAGUDEM

District To Which Belong WEST GODAVARI

Marital Status MARRIED

Spouse Name KANAKA DURGARAO ANGARA

Place of Birth Of Husband/Wife KAPAVARAM

Present District WEST GODAVARI

Present Address 2-91,GOLLAGUNTA STREET,KAPAVARAM,PALACOLE,534250

Permanent District WEST GODAVARI

Permanent Address 2-91,GOLLAGUNTA STREET,KAPAVARAM,PALACOLE,534250

Designation -

Period From Month/Year -

Period To Month/Year -

Office Address -

Have you been at any time

dismissed/removed from service/ -
resigned to the post

PRECEEDING RESIDENTIAL DETAILS

From To Police Station &
Sl.No Residential Address
Month/Year Month/Year District
2-91,GOLLAGUNTA STREET,KAPAVARAM,PALAKOL
PALACOLE,WEST
1 01/2019 09/2019 MANDAL,WEST GODAVARI,ANDHRA PRADESH,PINCODE-
GODAVARI DT
534250

2-91,GOLLAGUNTA STREET,KAPAVARAM,PALAKOL
PALACOLE,WEST
2 01/2018 12/2018 MANDAL,WEST GODAVARI,ANDHRA PRADESH,PINCODE-
GODAVARI DT
534250

2-91,GOLLAGUNTA STREET,KAPAVARAM,PALAKOL
PALACOLE,WEST
3 01/2017 12/2017 MANDAL,WEST GODAVARI,ANDHRA PRADESH,PINCODE-
GODAVARI DT
534250

2-91,GOLLAGUNTA STREET,KAPAVARAM,PALAKOL
PALACOLE,WEST
4 01/2016 12/2016 MANDAL,WEST GODAVARI,ANDHRA PRADESH,PINCODE-
GODAVARI DT
534250

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PRECEEDING RESIDENTIAL DETAILS

From To Police Station &
Sl.No Residential Address
Month/Year Month/Year District
2-91,GOLLAGUNTA STREET,KAPAVARAM,PALAKOL
PALACOLE,WEST
5 05/2015 12/2015 MANDAL,WEST GODAVARI,ANDHRA PRADESH,PINCODE-
GODAVARI DT
534250

Father Details

Father Name SATYA MOHAN

Profession/Job No

Postal District WEST GODAVARI

12-4/2,NEAR CHAMBER OF COMMERCEBESIDE DURGA TEMPLE
Postal Address
,KOYYALAGUDEM,KOYYALAGUDEM,534312
Permanent District WEST GODAVARI
12-4/2,NEAR CHAMBER OF COMMERCEBESIDE DURGA TEMPLE
Permanent Address
,KOYYALAGUDEM,KOYYALAGUDEM,534312

EDUCATION QUALIFICATION DETAILS

Examination
Name Of School/College Entering Leaving RegNo & Police Station &
Course
Address Date Date Passed District
Details
APOLLO E.M SCHOOL,POLAVARAM
KOYYALAGUDEM,WEST
SSC/Matriculation ROAD,KOYYALAGUDEM PINCODE 06/2004 05/2005 1202632
GODAVARI
534312

PRASHANTI JUNIOR
Intermediate/Diploma 06/2005 05/2007 070562116 VIJAYAWADA,KRISHNA DT
COLLEGE,PATAMATA,VIJAYAWADA

SAMSKRUTI COLLEGE OF
ENGINEERING AND
Graduation/Professional GHATKESAR,RANGAREDDY
TECHNOLOGY,KONDAPUR,GHATKESAR 10/2007 11/2011 07U11A1239
Course DT
MANDAL,RANGAREDDY
DT,TELANGANA

Post Graduation --- --- --- --- ---

Any other Qualification --- --- --- --- ---

Case Details

Is Arrested By Police.convicted by Court Of Law Under any

No
state/central Laws

Have you ever been arrested No

Have you ever been prosecuted No

Have you ever been kept under detention No

Have you ever been bound down No

Have you ever been fined by a Court of Law No

Have you ever been convicted by a court of Law No

Have you ever been debarred from any examination or

rusticated by No
any university or any other educational authority/institution

Have you ever been debarred /disqualified by any Public

Service
Commission/Staff Selection Commission/or any other No
recruitment
board for any of its examination/selection

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10/16/23, 3:50 PM :: APGSAVM2019 ::

Is any case pending against you in any court of law at

No
the time of filling up this Antecedents form

Is any case pending against you in any University or other

educational
No
authority/institution/ at the time of filling of this Antecedents
Form?

Whether discharged/expelled/with drawn from any

training/institution under No
the Government or otherwise?

RESPONSIBLE PERSON DETAILS

First Preference Second Preference
Name in Full Sur Name ANGARA KANAKA DURGA RAO RAAMAANA SATYA MOHAN

Given Name If Any - -

Fathers Name ANGARA VENKATA NARAYANA RAAMAANA RUDRA MURTHY

House/Apart/Flat No 2-91 12-4/2

Street and Road GOLLAGUNTA STREET NEAR CHAMBER OF COMMERCEBESIDE DURGA TEMPLE

Village KAPAVARAM KOYYALAGUDEM

Mandal/Taluk PALACOLE KOYYALAGUDEM

Town/City AGARRU ATCHUTAPURAM

District WEST GODAVARI WEST GODAVARI

Pin Code 534250 534312

Urban/Rural RURAL RURAL

DECLARATION DETAILS
1. I hereby declare that the statements made In this form are true to the best of my knowledge and belief.
2. I am married / unmarried and have only one wife living ( delete which Is not applicable).
3. I am fully aware that furnishing of false Information or suppression of any factual Information in the Antecedents
Form would be a disqualification and is likely to render me unfit for employment under the Government.
4. I am also fully aware that If It comes to notice at any time during my service that false Information has been
furnished or that there has been suppression of factual Information in the Antecedents Form, my services would be
liable to be terminated solely on this ground.
Date Signature of the Candidate
Place (Full Name: )

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