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| |GEN |BC |SC/ST | |
|Self |Dependant | | | |National Level |State Level |
|(Length of Service) | | | | | | |
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|6. |PSEB employee |7. |Riot affected Sikh migrant of Nov. 1984 | | 8. |Widow/Divorcee/Etc. |
| | | | | | | |
|9. Domicile of |YES | |NO | | |
|Punjab | | | | | |
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|Candidates Name, Father’s name, address, telephone number, date of birth and category should be written on the reverse side of the Demand Draft |
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