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i3iF qrfu,
sF , F€rfu fi tffl uttlr5T Riqci 3Tfae (Junior
Paste Here
Judicial Assistant) t} RE 4o qti tit lTffi-2o24
Recent
3TTaiIT TT3T Passport Size
self attested
coloured photo
tie :- di Hfafas v¥|T 3Tfin € I ed aT7L i a qlf 37rfu fas I

rfu fro/ MPJA

Online Application No.

Category & Serial No. of candidate in List of

Candidates found Successful

1. 3rritrtF tFT " (ca ed fi (/) fin aniT) rfu st'tha

Name of candidate in block letters Mr. Mrs.

2. fin/qia tFT i]FT /Name of Father/Husband in Block Letters

3. ffl fafa /Date of Birth

3]iB tfl TTrm-ffro 01 /01 /2024 ch 3]iB .......... of ................... qi€ ............... fail

4 an/category aT©/URH 3Tfial/oBc I 3Tffl/SC ]3Tffl/ST I

5. fan/ sex
(un ul ¥ (/) fin rri)
gRI/ Male
I di/Female
I 3Tq / Other

;:at=H=#*±;O:;:ia:I:¥I±:;:::::;:::
8. {¥]T± qi]T fin, rfu vi ffiTds rfu
Pe rman entA ddres salo ng-wi thDi strict Stat e&P inco de

9. qfflfflT ZFT qar fin, rfu rty fiTds rfu

Corr espo nden ceAd dress alon gwith Dist rict, State &Pin Cod e
 Page 2 of 4
io. ha i./ Mobile NO.
11 €-fa 3TT€.a./ E-mail I.D.

12. afflfie f`±Tfa / Marital Status (Married/Unmarried)

qfa farfu a al/If Married then
qri af th/Number of living Children
6-01-2Ooi a FIT tPliF # nd ed a iFT
/ Name & Date of Birth of children

I I
om after 26-01 -2001
3ffi ed a5T qflTF gquT e]T/ Whether last
elivery of child was of twins ?
13. fflT 3m enrfu q5ian ¥ /AreyouGovt.Employee? Ef/Yes
qfa a /If, yes
qt= "/ Name of post I iiiiiiiiiiiiiEl
± ar ilTT/Name of office
cr,iqcct7ict a 3Trfu/Period of Service

fas a/FromDate I I fas fitF/ TillDate

fflT 3Tri qflen fi flfffi an te 3ri fa`TTTT a * If /yes ITS/NOD

3T5qfa rm tfi a?
Whether you have obtained permission from your concerned
department prior to appearing in examination ?

3T5Ffa # fan / Date of permission

qFT TTFT fin Er rna rfu Full Addres sofo fflce alongwith Distri ct& State

14. IteTffro in t5T faFT :-

H. qflan ffl in as/fafa/cpcTDetaii Of qlTan tFT at`
3F. qifro/3itF/Tfa qft q* a
1 at iiEF
2

4
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fan an
5 an giv
6 ng rfu ffrHFTfan
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 Page 3 of 4
15. fflT 3rm apfl Pr© fan Ta a 3ife/3Te]qT maT 3Trqt} faffi apfl q* EifDff FiT]en
fan iqiqiffl/erri fi qiRE/falith/fry §3TT a 7/ Whether you were ever

:eITg:::::e#:1:gh/:t,:;ros::yoffr::i:::t;:Sue'?Ln5a/n¥e:Our:ollcefa;i£:have±en
ire ti, ch qFTa qjT fa" ca gp fife 3Te]qT 3ffir 3ITfu tfl Hffl qfffi 3flin qF
a} eneJ th t5€ / If yes, attach the certified copy of judgment or final order with
application form by giving details :-
fl.3F. 3Tq" fro rm riiFL fife

jtE: - FtFwl tPr ch 3TGT5 an qi{, Tffi a fatRT in q5t

16. apT 3TTqtch apft fan ch TIT ffi t} th fan qt5iir # 3ii!iimicHch a,iqrq|€^i i
rfu fch TTtlT a 3Te]tIT 3Tm6 ffii5a * t5Tan a TT€? qf± a, al
TeltF a fa" in q5€/ Whether you were ever punished in any disciplinary
proceedings during service or any disciplinary proceedings have been done against you?
If yes,attachthedetailsseparately. ti/Yes I Tfi/No I

17. qqT 3mri apft qflen F 3T5fha m7ilf tFT Bwh ed t} far, 5iF ffliqTaq, F.H. 3Te7tIT
fan 37iT fldi vi:a7T EiiT Hfun fin iiqT € ? Ff± 5, al T9TtF a faFT wi
#/ Have you ever been debarred by High Court of M.P. or any other government body
for using unfair means in any examination ? If yes, attach the details separately.
ti/yesH ia/No I
18. iii+i€ii€itl ¢<tliauii ZHFTUT qit tft <fi!+IiliDici toitii!iiatji 3TTaiH t} Hi2T fflfin t} gil H q I {

th fa5IT eniT € I Ewh/rmuT tT= a wh (/ ) 3Te7tiT o() a5T fin ut :-

Self attested photocopies of following Documents/Testimonials are to be submitted
serial-wise accordin to table attached with this Application Form. Mark (J) or (x)
in front of Documents : -
S.No. fatrFT / Particulars haj/PageNO. Tick//x

I orTaff ti a th qiiTtit 3Tra5i¥ ti dr tfittm Two recent passport

size coloured photograph of the candidate
2 3ff© qflen q5T rd 3TTaffl, fan rmT fat Tra gas tFT iF¥ wh
a, ar fife 3IT3i=/ Print out of Complete Application of Online
Examination, which clearly mentions the fee deposited.
3 GTffi weft ±/ Documents related to the date of birth
4 fan (faiFFT) pT7iuT pI (© as ETRT di) specially abled
(Handicapped) certificate (issued by Medical Board)
5 ffi rmiuT qT 37.fa.al/37ffl/3]i5]tIT ts (ueFT 3TRE 5i¥T th ) Caste
Certificate for OBC /SC/ST (issued by competent authority)
6 FtHHtr tFT iF frm rmuT TT (fro F.H. t} iF faffi ts, ffle]TT 3TRE
gl{T ffla) Domicile Certificate ofM.P. (Only for M.P. Domicile, issued by
competent authori ty)
 Page 4 of 4
7 ue]TT 3Tfun tFT 3FTTqfa FTTUT u7 (ae aiiL a) Noc Of competent
Officer (if applicable)
8 tl8Tfha in3ff tideft 3Tq5 qp, rmTTT qT] Ta 8qrfeffi (rfe al/aiiiF
di a, qfa fflTi a);
Mark Sheets, Certificates & Degrees of Educational Qualification
(Copies of every year/semester, if applicable)
9 GTq gT]TUT TTi*/± (ire ti)/Other certificates/documents (If
any)

ch :- HtFa wh TTa 3Txp9ff 3TTaTFT t7= al qTT} a nd, fa€ife iQ7T] uT 3rm¥qtF 5TT a 3ri Efflie7T
6Ttr HT]ifT ~ tft `tcisi"itia tpl<il!+latjT, 3fiTdTET t# aTwh a RE try al irfu qTfltfrE flTF
th wlaiTTt5 rfu fan i itgt5¥ ed i3;ti¥ q€ tFT iFT fan gq frm fry tan), H€iitlriq.
aTaT, 7]ev rfu sffl qTqTan, i@qag¥ giv rfu), fin ds-482Ooi @ 3ir Fu rfu 5a fflqTan-,
tlqtlgt # 3TTqtF enqT (Inward section) t} mzFT a dTfin 3TeztIT €1ffi tS alit fflT at I Tf fiT a lT`
Ir rfu q3T fas-07 de, 2025 t]i5 elqm ed qed 3rfffi: 8qfa qa qt qgr in FrRT I
ffuifin flT]q q iQ]T] qT 3TraiFT Fan # faTrm 3TTaffi # an I fRE HFq I iQm q¥ 3rriiFT iT
qgr wh # fteTfa fi, 3maeff an 3T`rfu fha tit ffl ffi a I

Eg!Le:-The candidate declared successful, after filling up Application Form, must sign on the place
prescribed and attach self attested copies of all documents alongwith copy of receipt generated at the
time of submitting online application & 2 recent coloured photo by putting it in the envelope by
writing name of post on top of envelope and submit it to the Principal Registrar (Exam),
Administrative Building, High Court of Madhya Pradesh, Jabalpur (Madhya Pradesh), Pin Code-
482001, by post or by hand in Inward Section of High Court of Madhya Pradesh, Jabalpur. The
complete filled application form must reach on or before 07th ADril` 2025 on the given address. It
will be the sole responsibility of the candidate that application form should reach within time at
prescribed place. In case of non reaching of application form within time at prescribed place, the
candidature of candidate may be cancelled.

tin
S qE in trm/ffi a fS ffiTin a rfu HT]iFT fffi al 3T# iTng qE I
tlT]F fin a I Gqha HT]RI Grrrfu R im tr fa- t} 3i]fflT Hfl tr rd a I ife fan aPr
tit qT ri€ iPr tTTffi 3]HRI 3ife/3Te]tlT 3Ttr qts ffi i al tt ffii5€ fflcha tfl i]TtFT $
3Tha tife fin i]T HtFt]T € 3]e7tIT giv i3ffl fflTtmaq EiiT qt= a E€m ffl fltrm € I

Declaration
I declare that I have thoroughly read and understood the terms and conditions
of examinations, the particulars furnished above are true, complete and correct to the
best of my knowledge and belief. If at any stage any information is found to be false
and/or incomplete, action will be taken against me and I may be disqualified or I may
be removed from the post by High Court.

{VI /Place tiTaff a EfflgR

ffro/Date: Signature of Candidate