GOVERNMENT OF PAKISTAN

Benazir Income Support Program

“F” Block, Pak Secretariat,
Islamabad
*****
Employee ID: 2309

Photo

Verification Roll for employee holding appointment in BISP under the

Government to be filled in by the employee in his own handwriting
/typed to be signed on every page of the form.

1. Name of the post on which the employee is appointed.

Assistant Complaint

2. Full name (in block letters) with surname and aliases if any
Mr/Miss/Mrs.

Click here to enter text.

3. Previous name (if any) and reasons for change

Click here to enter text.

4. Father's name in full with occupation and income (if any)

5. Date and place of birth of the employee given full address

Click here to enter text.
6. Description
a)

1. Height Click here to enter text.

 2. Build i.e. Click here to enter text.
Heavy/medium/light
3. Frame i.e. Click here to enter text.
Large/medium/thin
4. Complexion Click here to enter text.

5. Colour of hair Click here to enter text.

6. Colour of Eyes Click here to enter text.

7. Visible mark of Click here to enter text.

identification
b)

8. Religion by birth Click here to enter text.

9. Present Religion Click here to enter text.

7. Residential address (with telephone number if any)

a)
Present Click here to enter text.
b)
Permanent Click here to enter text.

8. Nationality

a) Pakistan National by Birth

b) If naturalized/migrated;
1 Previous Nationality & Address:Click here to enter text.
2 Date of Migration:Click here to enter text.
Citizenship/Naturalization certificate particulars i.e No. Date and place of Issue etc:
3
Click here to enter text.
National Identity Card No.Click here to enter text.

c. Date: Click here to enter text.

Place of Issue:Click here to enter text.

9. Local and other addresses during the last 10 years where the employee has stayed for more
than six months.
Address From To
Click here to enter Click here to enter
Click here to enter text.
text. text.

10. Educational qualifications showing places of education from the age of 10 years.

Name and Place of School Certificate/diploma

From To Major Field
land and college etc degree obtained
MSIT 2001 2003
B.A 1996 1998 Click here to Click here to enter
MATRIC 1988 enter text. text.

Note: A certificate of good character from the Head of Education Institute last attended by the employee
(to be attached)

11. Knowledge of language

ENGLISH ENGLISH
ENGLISH URDU URDU
Can understand can speak can write

12. Special training in any fields: Click here to enter text.

13. Any distinctions obtained in literary, sports or miscellaneous field

Click here to enter text.

14 Are you capable of sustained physical and mental activity?

a. Click here to enter text.

b. Have you had any serious illness or any operation in the past three years?
Click here to enter text.
How many days you lost from work in the past three years?
c
Click here to enter text.

15. Has there been any case of mental/nervous illness in your close relatives?.

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16 a. Do you take alcohol?

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b. Do you gamble?
Click here to enter text.
17. a. Government officers firms, with full description and addresses where the
employee previously worked and the reasons for leaving:
 Designation & Reason for
Officers/ Firms From To
Pay leaving
Click here to enter Click here to Click here to Click here to
Click here to enter text.
text. enter text. enter text. enter text.

b. Present occupation if any:

Designation &
Officers/ Firms From To Reason for leaving
Pay
Click here to enter Click here to Click here to Click here to enter
Click here to enter text.
text. enter text. enter text. text.
Note: Certificate of Performance from the Head of the Institutions last served by the applicant (to be
attached)

18. Officers/firms with full descriptions and addresses where the employee previously
applied without success.

Officers/ Firm When applied for appointment Job for which applied

Click here to enter text. Click here to enter text. Click here to enter text.

19. Particulars of wife (or husband as the case may be) of the employee:
a) Full Name with Father’s Name Click here to enter text.

b) Nationality Click here to enter text.

c) Religion Click here to enter text.

d) Date of birth Click here to enter text.

e) Place of birth Click here to enter text.

f) Occupation, if any Click here to enter text.

g) Income, if any Click here to enter text.

 20. Particulars of children:

S# Name Sex Date of Birth Recent Address

a Click here to enter Click here to enter Click here to enter Click here to enter text.
text. text. text.

21. Particulars of children or dependents educated or receiving education.

a. b. c. d. e.
Click here to enter Click here to Click here to Click here to
a. Name of Child
text. enter text. enter text. enter text.
Click here to enter Click here to Click here to Click here to
b. Relationship
text. enter text. enter text. enter text.
Click here to enter Click here to Click here to Click here to
c. Name of Institution
text. enter text. enter text. enter text.
Click here to enter Click here to Click here to Click here to
d. City/ Country
text. enter text. enter text. enter text.
Click here to enter Click here to Click here to Click here to
e. Period of Education abroad
text. enter text. enter text. enter text.
Click here to enter Click here to Click here to Click here to
f. How financed
text. enter text. enter text. enter text.

22. Full particulars of the employee’s near relations. Who are in Govt. service in Pakistan and elsewhere
specifying the posts held and where posted.

Name of relations Relationship Post held Place of Duty

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

23. Particulars of near relatives/dependents abroad;

Name with Relationship Nationality Occupation Place of resident

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

24. (a) Assets;

Immovable Value Mode of Acquiring

Click here to enter text. Click here to enter text. Click here to enter text.
 (b) Movable of more Than Rs. 10,000/-

Movable Value Mode of Acquiring

Click here to enter text. Click here to enter text. Click here to enter text.

Total Value: Click here to enter text.

25. Membership of Clubs Political Parties and Associations (Past and Present) Name of
Organization with date of joining and leave).

S.No Name of Club Party From To

Click here to
Click here to enter text. Click here to enter text. Click here to enter text.
enter text.

26. Details of travels Abroad (including travels for education or training)

Passport particulars, if any Click here to enter text.

Including No. date and place of issue Click here to enter text.

Course for which valid Click here to enter text.

Issuing authority Click here to enter text.

Click here to enter text.

Period of Validity

27. Names with addresses of at least two references in Pakistan who can testify to the
employee’s character and antecedents:

Name Address

Click here to enter text. Click here to enter text.

Click here to enter text. Click here to enter text.

28. Name or address of your close friends

Name Address

Click here to enter text. Click here to enter text.

Click here to enter text. Click here to enter text.

 29. Whether arrested prosecuted, convicted, restricted
or extend in any case, political or otherwise if so Click here to enter text.
full particulars including dates should be furnished..

30. Finger Prints

Place Click here to enter text. Date Click here to enter Signature Click here to enter
text. text.

a. I Click here to enter text. holding appointment in BISP as Click here to enter text.hereby
certify and solemnly affirm that my answers to the above question are correct to the
best of my knowledge and belief.
b. I fully understand that if the above statement is false in any material respect, or omits
any material information my appointment is liable to be rejected/terminated and shall
render me to legal land disciplinary action including dismissal if I am already in
government service.

Signature Place Click here to enter text.

Date Click here to enter text.

________________________________________________________________________________
To be filed in by the Superintendent ofPolice, etcconcernedattherequestof Benazir Income
Support Program.
Remarks by

Superintendent of Police Place: ……………………………….

Date: ……………………………….

D.I.G Special Branch Place: ……………………………….

Date: ……………………………….

Director Intelligence Bureau Place: ……………………………….

Date: ……………………………….
 Annexure

FAMILY PARTICULARS

NOTE: Full information in respect of Wife (husband in case of female employees), Father, Mother, Brothers, S isters, Father-in-Law and Mother-in-Law shouldbe
furnished as under. In case of wife (or husband as the case may be) additional information in respect of her maiden name, date and place of birth,
dateand place of marriage, nationality and religion before marriage should also be furnished in remarks column.

Full Name Relationship Age Nationality Religion Sect Occupation Whether Residential Political Remarks
with dependent address affiliations
Complete on you if any
details

1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11)

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enter text. here to to enter here to here to to enter to enter to enter to enter enter text.
text.
enter text. enter enter text. text. text. text.
text. text. text.