HIGH COURT OF BOMBAY
Application Form for The Post of PEON/HAMAL/FARASH
Registration-ID :- PEN194159
Name of Establishment :- Bench at Aurangabad
for which applied
Name of the Applicant :- Shri. NAYAN ROHIDAS CHAVAN
Address for correspondence :- LIMBALA TANDA TQ
SENGAON DIST HINGOLI
POST YELDARI 431510
District of Postal Address :- PARBHANI - 431510
Aadhar Card No. :- 463587547067
Mobile No. :- 9158616806
Email :- nrchavan12@[Link]
Nationality :- Indian
Is the Candidate Domicile :- Yes
of Maharashtra
Gender :- Male
Religion, Category/Caste :- Hindu, Vimukta Jati (BANJARA)
Date of Birth :- 25/11/1998
Place of Birth :- LIMBALA TANDA
Age as on 08/12/2025 :- 27 Years 0 Months 13 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 ZPPS LIMBALA 2011 689 900 Ist 76.56
STD.) TANDA
S.S.C. (S.S.C.) MAHARATRA 2014 301 500 Ist 60.20
STATE BOAR
H.S.C. (Arts) MAHARATRA 2016 427 650 Ist 65.69
STATE BOAR
Special Skills :- Yes ( MS-CIT )
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) RENUKA BADRINATH RATHOD
respectable persons who SARPANCH
know the candidate. 9307262693
LIMBALA TANDA TQ SENGAON DIST HINGOLI
POST YELDARI 431510
2) SUNITA ROHIDAS CHAVAN
UP SARPANCH
9158616806
LIMBALA TANDA TQ SENGAON DIST HINGOLI
POST YELDARI 431510
Fee Details :- Payment Gateway:- SBI Collect
Payment Type :- ePayment
SBCollect Ref. No.
:- DUP0723915
Date :- 06/01/2026
Amount :- Rs. 1000
Signature of Applicant
FOR OFFICE USE
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Signature of Applicant
Printed on 06/01/2026 16:54:14
Page 3/4
DECLARATION - I
1) I the applicant, Shri. NAYAN ROHIDAS CHAVAN 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.
NAYAN ROHIDAS CHAVAN
Place : PARBHANI
Date : 06/01/2026
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. NAYAN ROHIDAS CHAVAN son/daughter/wife of Shri ROHIDAS CHAVAN aged 27
years, resident of PARBHANI 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.
NAYAN ROHIDAS CHAVAN
Place : PARBHANI
Date : 06/01/2026
Name and Signature of Applicant
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