National Human Rights Committee (R)

Award Nomination / Application Form

1. Award Information
प्रशस्ति माहिती (ಪ್ರಶಸ್ತಿ ಮಾಹಿತಿ)

Name of Award *

Category *

Application Type *

Self-Application

Nominated by someone else

2. Applicant/Nominee Details
ಅರ್ಜಿದಾರರ / ನಾಮನಿರ್ದೇಶಿತರ ವಿವರಗಳು

3. Achievement Profile (Professional Description)
ಸಾಧನೆಯ ವಿವರ (ವೃತ್ತಿಪರ ವಿವರಣೆ)

Please describe your achievement briefly and clearly.

Main areas of achievement

Impact on society

Period of service rendered (in years)

4. Checklist of Documents to be attached
ಲಗತ್ತಿಸಬೇಕಾದ ದಾಖಲೆಗಳ ಪಟ್ಟಿ

Passport Size Photo (Required)

Copy of Aadhar card / Identity card

Press reports or photos confirming the achievement

Copies of previous awards or certificates

Letter of recommendation (if any)

Annexure (Additional Information Sheet, optional)

5. Declaration
ಘೋಷಣೆ

All the information given by me is true and correct to the best of my knowledge. The committee has full authority to conduct any investigation into my achievements. I will abide by the final decision of the award committee.

Place

Date

Applicant's Signature

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Date of Application Received

Signature of Reviewing Officer

Award Approval Status

Approved Rejected

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National Human Rights Committee (R)

Award Nomination / Application Form

OFFICE USE ONLY