HIGH COURT OF BOMBAY
Application Form for The Post of PEON/HAMAL/FARASH
Registration-ID :- PEN206523
Name of Establishment :- Bench at Aurangabad
for which applied
Name of the Applicant :- Shri. KUNDAN PRAVIN RATHOD
Address for correspondence :- AT TULSHINAGAR POST
KALI DAULAT KHAN TQ
MAHAGAON DIST
YAVATMAL
District of Postal Address :- YAVATMAL - 445204
Aadhar Card No. :- 476594161881
Mobile No. :- 8208148003
Email :- rathodkundan011@[Link]
Nationality :- Indian
Is the Candidate Domicile :- Yes
of Maharashtra
Gender :- Male
Religion, Category/Caste :- Hindu, Vimukta Jati (BANJARI)
Date of Birth :- 10/09/2005
Place of Birth :- TULSHINAGAR
Age as on 08/12/2025 :- 20 Years 2 Months 28 Days
Marital Status :- Single
Whether Candidate is :- No
Differently-abled Person?
Does the candidate have 7 :- Yes
Standard (passed)
marksheet issued by the
School Authority?
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Educational Qualification :-
Course/Degree Board/University Year of Marks Out of Class Percent
Passing Obtained Marks %
Below S.S.C. (7th V N V KALI 2018 893 900 Ist 99.22
STD.) DAULAT
S.S.C. (S.S.C.) S B OF 2021 398 500 Ist 79.60
MAHARASHTRA
H.S.C. (Science) S B OF 2023 451 600 Ist 75.17
MAHARASHTRA
Special Skills :- No
Language Known :-
Read Write Speak
Marathi Yes Yes Yes
Hindi Yes Yes Yes
English Yes Yes No
Does candidate work in any :- No
Government Department ?
Whether candidate has :- No
enrolled his/her name at
Employment Exchange?
(a) Is there any criminal :- No
proceeding pending against
the candidate?
(b) Is he/she convicted by a :- No
Criminal Court?
(c) Is he/she facing :- No
disciplinary/deparment
enquiry?
Whether permanently :- No
debarred or disqualified by
any Court/MPSC/UPSC or
any State Service
Commission from
appearing in any
examination conducted by
them?
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Name and address of two :- 1) KIRAN DINESH RATHOD
respectable persons who POLICE PATIL
know the candidate. 8888027171
AT TULSHINAGAR POST KALI DAULAT KHAN TQ
MAHAGAON DIST YAVATMAL
2) ARCHANA SACHIN JADHAV
SARPANCH
9623333920
AT TULSHINAGAR POST KALI DAULAT KHAN TQ
MAHAGAON DIST YAVATMAL
Fee Details :- Payment Gateway:- SBI Collect
Payment Type :- ePayment
SBCollect Ref. No.
:- DUP0998432
Date :- 13/01/2026
Amount :- Rs. 1000
Signature of Applicant
FOR OFFICE USE
Affix your
passport size
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Signature of Applicant
Printed on 13/01/2026 19:40:39
Page 3/4
DECLARATION - I
1) I the applicant, Shri. KUNDAN PRAVIN RATHOD do hereby declare that no criminal prosecution pending against
me or I have not been convicted by a Criminal Court or held guilty or facing disciplinary enquiry.
2) I further affirm that all the details filled in the application are true and correct as per my knowledge. If any
information is found to be false/incorrect, I will be liable to be disqualified from the process of selection and if
selected/appointed, my services would be liable to be terminated without any notice.
KUNDAN PRAVIN RATHOD
Place : YAVATMAL
Date : 13/01/2026
Name and Signature of Applicant
DECLARATION - II
Form-A
(See Rule 4 of Maharashtra Civil Services (Declaration of Small Family) Rules, 2005)
I, Shri./Smt./Kum. Shri. KUNDAN PRAVIN RATHOD son/daughter/wife of Shri PRAVIN RATHOD aged 20 years,
resident of YAVATMAL do hereby declare are follows :
1) That I have filled my application for the post of Peon/Hamal/Farash.
2) I have -NA- (Number) living children as on today. Out of which -NA- No. of children born after 28/03/2005 is
-NA- (mentioned dates of birth, if any)
3) I am aware that, if any total number of living children are more than two due to the children born after 28/03/2005, I
am liable to be disqualified for the same post.
KUNDAN PRAVIN RATHOD
Place : YAVATMAL
Date : 13/01/2026
Name and Signature of Applicant
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