Application Form for Consideration for Appointment as President/ Member/ Member(Woman) 1. Full Name (in block letters) : 2. Present address for correspondence with phone no. and email address (if any). Pin Code if available email address Permanent address: 4. Date of Birth (with proof along with 5. Details of Educational Qualification (Matriculation onwards) Sl. Name of examination/ Degree Year of completion Name of Board/ University Division/% of marks/Grade An attested Passport size photograph Dr Mr Mrs Miss Yes No Phone no. Pin Code email address Phone no. 3. copy of relevant document.) / Examining Body 1. 2. 3. 4. 5. No. 6. Details of Experience. No. Sl. Designation Employer Organization Field of experience Economics Law/Commerce/Accountancy/ Industry/ Public affairs/ Administration. Period of experience (completed no. of years) Whether full time part time 1. 2. 3. 5.4.3.2.1. 6. Government of Orissa Published on National Portal of India (india.gov.in) Department of Food Supplies & Consumer Welfare 7. Details of any other work done/ project completed or any other information relevant to suitability of the candidate for the proposed appointment: Sl.No. Description of work/ project/ nature of information. Description of documentary evidence of information. 8. Post applied for: 9. Preference (if applies for more than one district):President Place: Date: Signature of the Applicant & NAME List of documents enclosed: 3. 2. 1. PRESIDENT MEMBER District Forum 3. 2. 1. Member 3. 2. 1. 5. 4. 3. 2. 1. 10. 9. 8. 7. 6. Published on National Portal of India (india.gov.in) Form of Affidavit In the Court of Executive Magistrate/ Notary Public I, Kumari/Smt./Sri 2.I do not belong to or have Membership of any political party or any communal organization. 3.I have not got any financial or any other interest(s), which is/are likely to affect prejudicially the discharge by 4.That I have not been removed or dismissed from the service. 5.That I have carefully gone through and have fully understood the provisions of clause (a)/(b) of mentioned in proviso thereto which may disqualify me from being appointed as President/Member of the District That the facts stated above are true to the best of my knowledge and belief. I am swearing this affidavit for offering my candidature for appointment as President/ Member in the District Consumer Disputes Redressal Deponent Identified by me Advocate son of wife of daughter of aged years,residing at do hereby affirm that: swear solemnly me of the functions as a President/ Member of District Forum, Sub-Section (1) of Section 10 of the Consumer Protection Act, 1986 and I have not incurred any of the conditions Consumer Disputes Redressal Forum. Forum. The above deponent being identified by Advocate solemnly affirms and states that the facts stated above are true and correct to the best of his/ her knowledge and belief and signed on this day of at ( HH:MM ) Deponent Executive Magistrate/Notary Public Published on National Portal of India (india.gov.in)
