Gurugram Police

Information on Domestic Help/Tenant/Employee

Particulars of Employer//Landlord
1. Sector/Village/Colony/Society
Passport
2. Plot no./Flat No. /House No./Street Size
No./Police Station Photograph

3. Name & Fathers name of Employer/Landlord with Mobile No.

i) Name of the Landlord/Employer

ii) Fathers Name

iii) Contact No. Signature of the

Applicant

4. Particulars of Employee/Tenant/Domestic Help

Full Name Phone No.
Alias
Father Name
Spouse Name Occupation
Nationality Age
Sex Caste

5. Permanent Address
House No.
Sector/Village/Locality
Police Station
District & State
Landline/ Mobile No.
Proof of Identity (Voter card/Driving License/Ration Card etc.)
Two References from 1.
Native Place (Name,
2.
Address & Ph. No.)

6. Local (Current) Address

House No. Residing at current address since
Sector/Village/Locality
Name of Landlord & Address Police Station
Police Post
Mobile No.

Two Local References 1.

(Name, Address & Ph. No.)

2.

7. Nature of Employment Place of Work

(Domestic Servant/Shop Employee/Industrial
Worker/Chowkidar/Dhobi/Tradesman/Craftsman
etc.)

8. Particulars of Previous Employment (in case of Employee)

Nature of Employment

Address

Particulars of Previous Employer (with mobile no.)

9. Particulars of Family members residing with the Tenant/Employee

Sr. No. Name Age Sex Relation Occupation Mobile no.

This is only Information Form. I am getting his/her Police

verification done separately by addressing the concerned jurisdiction SP (of permanent
address) in the prescribed Proforma.

Signed by

(Name)
Employers/Landlord.
Dated