APA REGISTRATION FORM - WIDOW / WIDOW WARD(OFFICER)
(USE BLOCK CAPITALS ONLY)
WIDOW   WIDOW WARD
Temporary Registration No with Date :  ____________________________________
Paste your
latest Stamp
size
Photograph
APA Registration Number with date
(will be filled by APA) : ______________________________________________
DETAILS OF DECEASED ARMY PERSONAL( HUSBAND / WIFE / FATHER / MOTHER ) :
1.   Personal Number :
Prefix
 
________________
Suffix
 
2.   Rank :    ____________________   

3.   First Name:    _______________________________         Middle Name :   _____________________________________  
   Last Name / Surname:   _________________________________________       Decoration, if any : ___________________
4.  Arms/Service :   _______________________________
    Day   Month Year     Day   Month Year
5.  Date of Commission :
   
   
       
6.    Date of Death :
   
   
       
7.    Death Occurred in :             ACTIVE SERVICE / PEACE / AFTER RETIREMENT/WAR
8.  Cause of Death :    ___________________________________________________________________________________
DETAILS OF WIDOW / WIDOW WARD
9.  First Name of Applicant : ________________________________________________________________
        Middle Name of Applicant : ________________________________________________________________
        Last Name/Surname of Applicant : ________________________________________________________________
10.  Date of Birth
      Day      Month         Year
:
   
   
       
11.  Date of Marriage
      Day      Month         Year
:
   
   
       
12.  Whether SC/ST/OBC/Gen : ________________________________________________________________
13.   Academic Qualifications : ________________________________________________________________
14.   Professional Qualifaction : ________________________________________________________________
15.   Work Experience (if any) : ________________________________________________________________
16. Job Preference
       (select maximum five Job Titles) 		: 1. __________________ 2. ____________________ 3. ___________________
  4.__________________ 5. ___________________  
17.   Place Preference
        (select maximum five stations) : 		1. __________________ 2. ____________________ 3. ___________________
  4.__________________ 5. ___________________  
18.  Salary Expected (Salary range ) :                 From : ____________________ pm             To ______________________ pm
  Permanent Address Present Contact Address
19.  Address : ____________________________________ ____________________________________
20.  State : ____________________________________ ____________________________________
21.  District : ____________________________________ ____________________________________
22.  Town / City : ____________________________________ ____________________________________
23.   Pin Code : ____________________________________ ____________________________________
24.   Telephone No. with :
        STD Code 		____________________________________ ____________________________________
25.   Mobile No : __________________________________________________________________________
26.   E-mail ID : __________________________________________________________________________
27.  Passport Details: (a) Passport Number: _____________________    (b) Valid upto : ______________________
Date       : (Signature of Applicant)