HIGH COURT OF BOMBAY
Application Form for The Post of PEON/HAMAL/FARASH
Registration-ID :- PEN1300
Name of Establishment :- Bench at Nagpur
for which applied
Name of the Applicant :- Shri. SACHIN BHIMRAO TAWAR
Address for correspondence :- At Bara Post Belkhed Ta
Umarkhed DIST Yavatmal
District of Postal Address :- YAVATMAL - 445206
Aadhar Card No. :- 893908229105
Mobile No. :- 9011595201
Email :- Sachintawar242@[Link]
Nationality :- Indian
Is the Candidate Domicile :- Yes
of Maharashtra
Gender :- Male
Religion, Category/Caste :- Hindu, General (Maratha)
Date of Birth :- 05/05/1993
Place of Birth :- BARA
Age as on 08/12/2025 :- 32 Years 7 Months 3 Days
Marital Status :- Married
No. of Living Child/Children 0
Child/Children born after 28/03/2005 0
Date of births of child/children born after 28/03/2005.
Whether Candidate is :- No
Differently-abled Person?
Does the candidate have 7 :- No
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 ZP SCHOOL 2007 50 100 IInd 50.00
STD.) BELKHED
S.S.C. (S.S.C.) MSBSHSE 2010 342 500 Ist 68.40
H.S.C. (Arts) MSBSHSE 2014 261 650 PASS 40.15
Special Skills :- Yes ( DRIVER. OFFICE WORK. )
Language Known :-
Read Write Speak
Marathi Yes Yes Yes
Hindi Yes Yes Yes
English Yes Yes Yes
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) SADHANABAI SHAMRAO HARNE
respectable persons who SIRPANCH
know the candidate. 9075503093
At Bara Post Belkhed Ta Umarkhed DIST Yavatmal
445206
2) RAMESH NAMDEV KALE
POLICE PATIL
9623135974
At Bara Post Belkhed Ta Umarkhed DIST Yavatmal
445206
Fee Details :- Payment Gateway:- SBI COLLECT
Payment Type :- ePayment
SBCollect Ref. No.
:- DUO9516347
Date :- 16/12/2025
Amount :- Rs. 1000
Signature of Applicant
FOR OFFICE USE
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Signature of Applicant
Printed on 17/12/2025 13:48:04
Page 3/4
DECLARATION - I
1) I the applicant, Shri. SACHIN BHIMRAO TAWAR 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.
SACHIN BHIMRAO TAWAR
Place : YAVATMAL
Date : 16/12/2025
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. SACHIN BHIMRAO TAWAR son/daughter/wife of Shri BHIMRAO TAWAR aged 32
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 0 (Number) living children as on today. Out of which 0 No. of children born after 28/03/2005 is
(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.
SACHIN BHIMRAO TAWAR
Place : YAVATMAL
Date : 16/12/2025
Name and Signature of Applicant
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