Notesale: Turn your study into money

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jktLFkku yksd lsok vk;ksx] vtesj
lk{kkRdkj@vafre p;u gsrq foLr`r vkosnu lg ifjfujh{kk izi= Hkjus gsrq vkosndksa ds fy, vko';d funsZ'k
¼vkosnd bu funsZ'kksa dks vius ikl j[k ysa½
1- vkosnu&i= 'kqYd%& vH;FkhZ 50 #i;s ds foLr`r vkosnu&i= 'kqYd gsrq rnuq:i Hkkjrh; iksLVy vkMZj layXu djsA ;fn
a
vH;FkhZ dks lk{kkRdkj gsrq mifLFkr gksus ds fy, funsZf'kr fd;k x;k gS] rks vk;ksx esa udn jkf'k Hkh tek djk ldrs gSaA
2- vkosnu&i= Hkjuk%& vkosnd vkosnu&i= Hkjus ls iwoZ bu funsZ'kksa ,oa foKkiu dks /;ku iwoZd ia+
,oa funsZ'kksa dk vuqikyu u djus ij vkosnu&i= vLohd`r fd;k tk ldrk gSA
uksV %&vkosnd vkosnu&i= Lo;a ds gLrys[k esa HkjsaA vkosnu&i= funsZ’kkuqlkj o fcuk fdlh izdkj dh dkV&N¡WkV ds
Hkjk tk,A izR;sd dkWye esa pkgh xbZ lwpuk iw
...
kZ ekudj jnn~ fd;k tk ldrk gSA vkosnd ds
+
gLrk{kj jfgr vkosnu&i= vLohd`r dj fn;s tk,axsA vkosnu&i= esa dh xbZ fdlh Hkh izfof"V ds lq/kkj gsrq izkFkZuk&i=
Lohdkj ugha fd;k tk,xkA leLr vko';d ¼tSls 'kS{kf
...
k&i=ksa dh LogLrk{kfjr izfrfyfi;k¡ vkosnu&i= ds lkFk layXu dj vo'; HkstasA
vkosnu i= ij viuk ikliksVZ lkbt dk uohure QksVks ¼foKkiu tkjh fnukad ds i’pkr~ dk f[kapk gqvk½ fu/kkZfjr LFkku
ij layXu dj iw
...
k&i=%& leLr vko';d o okaNuh; izek
...
kd@vk;q@vkpj
...
k&i=½ bl
foLr`r vkosnu&i= ds lkFk layXu dj Hkstuk vko’;d gS] vU;Fkk vH;fFkZ;ksa dks fu;qfDr dk ik= in ;k oxZ fo’ks"k dk
ykHk ns; ugha gksxk vkSj u gh bl laca/k esa fdlh izkFkZuk i= ij fopkj fd;k tk,xkA izek
...
k&i=%& ¼1½ vkidks viuh 'kS{kf
...
k&i=ksa@mikf/k;ksa dh LogLrk{kfjr izfrfyfi;ka Hkstuh gksxhA ;fn fdlh ijh{kk] tks vkius mRrh
...
k&i= layXu djsA
s
a

uksV%& ;fn vkosnd in dh visf{kr 'kS{kf
...
kZ ugha gS vkSj mldh vafre o"kZ dh ijh{kk esa
lfEefyr gqvk ;k gksus okyk gS] rks bldk Li"V mYys[k lacaf/kr dkWye esa djs rFkk laLFkk iz/kku ls izi=&3 izekf
...
k&i=%&
¼1½ lk/kkj
...
Mjh@gk;j lSd
...
k&i= esa nh gqbZ tUe fnukad ds vfrfjDr vU;
fdlh izek
...
Mjh@gk;j
lSd
...
k&i= dh izekf
...
k&i= esa
mfYyf[kr tUe fnukad dks Lohdkj dj ldrk gSA blds fy;s vkosnd dks pkfg;s fd og vius fo|ky; ds
izek
...
kr djkdj mn~/k`r dj ldrk gSA
¼2½ ;fn vki fu/kkZfjr vf/kdre vk;q lhek ls vf/kd vk;q ds gSa vkSj vk;q lhek esa NwV pkgrs gSa rks foKkiu esa fn;s
x;s vk;q laca/kh ftl micU/k ds vUrxZr NwV pkgrs gS ml vk'k; dk] ;Fkk jktLFkku ljdkj ds LFkkbZ
deZpkjh@vuqlwfpr tkfr@vuqlwfpr tutkfr@fiNM+k oxZ@fo’ks"k fiNM+k oxZ@fu%'kDr O;fDr vkfn dk Li"V
izek
...
kZ gksus ls iwoZ rd gh NwV laca/kh izko/kku gks tkus ij ekU;½
3- fdlh oxZ fo'ks"k esa fu/kkZfjr NwV ml oxZ fo'ks"k ds fy, fjfDr esa vkjf{kr in fo|eku gksus ij gh iznku fd;s
tk,axsA
4- ;fn fdlh in esa efgyk oxZ ds fy, fjfDr ugha gS] rks mls dsoy ml in@oxZ ds fy, fu/kkZfjr lkekU; NwV
gh iznku dh tk,xhA vFkkZr~ mls ml oxZ esa iq:"k dks ns; NwV ds vuq:i gh NwV nh tk,xhA

5- vk;q dh x
...
kuk foKfIr ds vUrxZr vkosnu ysus ds o"kZ dks gh 1 tqykbZ dks dh tk,xhA Ldwy
f'k{kk ds inksa gsrq vk;q dh x
...
kZr vk;q lhek esa NwV ds izko/kku vlap;h (Non Cumulative) gS]
vFkkZr vH;fFkZ;ksa dks mijksDr of
...
k lac/kh izek
...
k laLFkk ds vkpk;Z }kjk iznRr izek
...
k&i= Hkstus dh vko';drk ugha gSa ysfdu blds cnys esa LFkkbZ jkT;

deZpkjh gksus dk izek
...
k&i= %& tks vkosnd jktLFkku dh fdlh vuqlwfpr tkfr@vuqlwfpr tutkfr@fiNM+k oxZ@fo’ks"k fiNM+k
oxZ ds gksa] mUgsa pkfg, fd os blds izek
...
k&i= izLrqr djsa tks fd vkosnu i= izkfIr dh vfUre fnukad ds iwoZ vkSj uohure tkjh gks] vU;Fkk vH;fFkZ;ksa dks oxZ
fo’ks"k dk ykHk foKkfir inksa gsrq ns; ugha gksxk %&
i
...

iii
...

v
...
(not below the rank
of Ist Class Stipendiary Magistrate)
...

Revenue Officer not below the rank of Tehsildar
...

Administrator/Secretary to Administrator/ Development Officers (Lakshadeep Island)
...
k&i=
foLr`r vkosnu&i= ds lkFk izLrqr djuk vko’;d gS] vU;Fkk mls bl oxZ dk ykHk ns; ugha gksxkA ifr ds uke
ls tkjh tkfr izek
...
k
i= ds lac/k esa ;g Hkh lqfuf’pr dj ysa fd
a
o fuokl LFkku ,oa dzhehys;j@ukWu dzhehys;j dh izfof"V;ka fu/kkZfjr izi= ij lgh&lgh ,oa iw
...
k dk ykHk ns; ugha gSA vr% ,sls vH;fFkZ;ksa dks lkekU; vH;FkhZ gsrq
fu/kkZfjr in o vkosnu&i= ij vkosnu djuk gksxkA
o fiNM+k oxZ@ fo’ks"k fiNM+k oxZ gsrq izek
...
k i= fu;ekuqlkj ekrk&firk dh vk; ds vk/kkj ij ¼fookfgr efgyk vH;FkhZ dks Hkh ekrk&firk dh
vk; ds vk/kkj ij½ l{ke vf/kdkjh }kjk jktLFkku jkT; ljdkj }kjk fu/kkZfjr izi= ij tkjh fd;k gqvk
gksA
¼M-½ fu%'kDrrk izek
...
kh esa vkrk gS] og blds izek
...
k&i= layXu dj
vo'; Hkstsa] vU;Fkk vk;ksx }kjk mls fu%'kDr O;fDr dh Js
...
kh vuqlkj fuEu
dksM Hkjsa&
fu%'kDrrk Js
...
kh iw
...
kZr% va'kr% nksuksa
va/k
01

va/k
02

n`f"V
03

iSj
01

gkFk
02

nksuksa
03

iSj
04

gkFk
05

furac
06

nqcZyrk
07

01
02
fu%'kDrrk dksM
¼p½ vuqHko lac/kh izek
...
k esa fofHkUu inksa ij dk;Z djus dk fnukad lfgr
a
izek
...
k&i= vkosnu&i= ds lkFk layXu dj HkstasA
¼N½ fookg laca/kh izek
...
k i= layXu djsa
vkSj ;fn rykd'kqnk gSa rks Hkh bl lEcU/k esa izek
...
k iathd`r ugha gqvk gS ;k vfuok;Z fookg iath;u ykxw gksus ls iwoZ lEiUu gksus ds dkj
...
k ls NwV
pkgrk gS] rc Hkh og bl gsrq iw
...
k lfgr viuk 'kiFki= izLrqr djsA
4- lsokjr vH;FkhZ& tks vkosnd lsokjr gS ¼LFkkbZ gks ;k vLFkkbZ½ mUgsa viuk vkosnu&i= lh/ks gh vk;ksx dk;kZy; dks
Hkstuk pkfg, vkSj bl lEcU/k esa vius fu;qfDr vf/kdkjh@foHkkxk/;{k dks vo'; lwfpr dj nasA ;fn dksbZ vkosnd viuk
vkosnu&i= vius fu;qfDr vf/kdkjh@foHkkxk/;{k ds ek/;e ls Hkstrk gS vkSj og vk;ksx dk;kZy; esa vkosnu&i= izkfIr
ds vfUre fnukad ds ckn igqaprk gS rks ml izkFkZuk&i= ij vk;ksx }kjk fopkj ugha fd;k tk,xkA Hkys gh vkosnd us
izkFkZuk&i= vius fu;qfDr vf/kdkjh dks vfUre fnukad ds igys gh izLrqr fd;k gksA
uksV%& vkosnd dk nkf;Ro gksxk dh og lk{kkRdkj ls iwoZ vius foHkkxk/;{k@dk;kZy;k/;{k ls vukifRr izek
...
kkFkhZ ;k ¼p½ LFkkbZ :i ls clus ds fopkj ls
ikfdLrku] cekZ] Jhyadk] iwohZ vÝhdh ns'k dhfu;k] ;qxkUMk vkSj la;qDr ratkfu;k x
...
k&i= izLrqr djuk pkfg,A
6- ;k=k HkRrk%& lk{kkRdkj ds fy;s cqyk;s x;s jktLFkku ds csjkstxkj vkosndksa dks muds fuokl LFkku ls lk{kkRdkj ds
LFkku rd dk lk/kkj
...
kh ds Vªsu fVdV dk fdjk;k fn;k tk,xkA ¼fVdV izLrqr djsa½
7- vkosnd dks vkosnu&i= ds lkFk dksbZ Hkh ewy izek
...
k&i= dks okil ykSVkus dk nkf;Ro vk;ksx dk ugha gksxkA
8- izR;sd izkFkhZ dk 'kkjhfjd ,oa ekufld :i ls LoLFk gksuk vko';d gS vkSj mls fdlh izdkj dh fpfdRldh; ijh{k
...
k ns[k ysa fd os mlds vuqlkj ;ksX;rk j[krs gSa ;k ughaA
10- vkosnd dks mlds vkosnu&i= ds vfUre ifj
...
kZ ckr fNik,xk] rks mls vik= ?kksf"kr dj fn;k
tk,xk vkSj ;fn jkT; lsok esa gS] rks lsok ls i`Fkd fd;k tk ldsxkA
14- ;fn vkosnd ds irs esa ifjorZu gks rks vk;ksx dk;kZy; dks vo'; lwfpr djsA vk;ksx dk;kZy; }kjk ifjofrZr irs dk
a
/;ku j[kk tk,xk fQj Hkh ifjofrZr irs ij i= eaxokus dh O;oLFkk ds fy, vkosnd Lo;a mRrjnk;h gksxkA
15- fdlh lsok fo’ks"k es vko’;drk gksus ij lsok izkFkfedrk dze] vuqHko ;k [ksy Hkkj gsrq vfrfjDr ii= Hkjok;s tk ldrs
gaS] blds fy;s lac) foKfIr dk voyksdu dj ysa A
*****

dk;kZy; izfof"V

vkosnu izkfIr dh frfFk%&

izkfIr dzekad%&
izi=&1

vkosnu i= ds lkFk
lfpo] jktLFkku yksd
lsok vk;ksx ds uke 50
#i;s dk iksLVy vkWMZj
vo'; yxk,W

jktLFkku yksd lsok vk;ksx] vtesj
lk{kkRdkj] vafre p;u ,oa lh/kh HkrhZ gsrq
¼vkosnd }kjk nks izfr;ksa esa Hkjk tk,½

jksy uEcj

vkosnu i= Øekad

foKkiu la[;k

esfjV Øekad

¼vkWuykbu vkosnui= dk½

lkekU;

vkosnd dk
gLrk{kj;qDr
uohure QksVks

foLr`r vkosnu lg ifjfujh{kk izi=

¼dsoy vafre ifj
...
k oxZ
fiNM+k oxZ
fo'ks"k
vuqlwfpr vuqlwfpr tutkrh; {ks= ds
fiNM+k oxZ
tkfr
tutkfr ,l-lh- ,l-Vh-

ckjkWa ftys ds fd'kuxat]
'kkgkckn rglhy ds lgfj;k

ewy fuokl o tUe LFkku
ftyk
rglhy

jkT;

vU; fVIi
...
kh ¼vkosnd lacf/kr dkWye esa **gk¡ ** vafdr djsA 'ks"k dkWye esa **X** dk fpà vafdr djsa %&
a
a
HkwriwoZ mRd`"V ,u-lh-lhefgyk
fu%'kDr ¼funsfZ 'kdkuqlkj dksM Hkh vafdr djs½a
vfookfgr

fookfgr

fo/kok

fofPNUufookg

n`f"Vghu@vYin`f"V

ewd cf/kj

vfLFkfoÑr] ,y-Mh-@lh-ih

lSfud f[kykM+h

¼lh-lfVZ-½

lsokjr deZpkjh
jkT; lsok deZpkjh

iapk;rh jkt@ lkoZtfud fuxe

foHkkxh; deZpkjh

vjktif=r deZpkjh

ea=kyf;d deZpkjh

1- vkosnd dk iwjk uke %
¼d½ fgUnh esa % Jh@Jherh@dqekjh ---------------------------------------------------------------------------------------------------------------------------------------------¼[k½ vaxszth esa ¼CykWd ysVlZ esa½% Mr
...
/ Miss ------------------------------------------------------------------------------------------------------------------2357-

¼v½ firk dk uke %------------------------------------------------------------------------------ ¼c½ ekrk dk uke %------------------------------------------------------------------vkosnd dh tUe frfFk% ---------@----------@-------------- 4- foKfIr esa fu/kkZfjr frfFk dks vk;q % o"kZ --------ekg ---------- fnu -------ukxfjdrk %&
Hkkjrh;@vU;-------------------------------- 6- /keZ%& ---------------------------------------------------------------------------------------oSokfgd fLFkfr%
vfookfgr
fookfgr
fofPNUufookg¼ifjR;Drk½
fo/kok
fo/kqj
iqufoZokfgr

8- fookg fooj
...
k ¼fookfgr gksus dh fLFkfr esa½ % ---------------------------------------------------------------------------------------------------------------------------Ø-lathfor iq=@iq=h dk uke
tUe fnukad
Ø-lathfor iq=@iq=h dk uke
tUe fnukad
1
4
2
5
3
6
10- dqy lUrku la[;k 1-6-2002 ls iwoZ %&
1-6-2002 ds i'pkr~ %&
11- i=&O;ogkj dk irk ¼e; Qksu@eksckbZy uEcj½ % ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------12- LFkkbZ fuokl dk iwjk irk %& --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------13- 'kS{kf
...
kh@
,sfPNd fo"k; dkslZ cksMZ@fo'o& iz;klksa
dk
o"kZ
dh fo|ky; dk
dh
mRrh
...
Mjh
gk;j lSd
...
Mjh@bUVj
Lukrd ¼ch-,-@
ch-dkWe-@ch-,llh-½
vf/kLukrd ¼,e-,@
,e-dkWe@,e-,llh-½
f'k{kk esa Lukrd
¼ch-,M@f'k{kk'kkL=h½
ik=rk ijh{kk&
¼usV@LksV@xsV@
dsV½
vU; dksbZ
mikf/k@fMIyksek

¼c½ bUVuZf’ki ¼;fn ykxw gks½ %&
o"kZ -------------------------------- ekg ------------------------------- fnu -----------------------------¼l½ jftLVªs'ku fooj
...
k

¼n½ in gsrq vko';d vuqHko izek
...
k

2

14- vfrfjDr foLr`r lwpuk %&
¼1½ ;fn vkius iwoZ esa 13 ¼n½ dh lwpuk ls fHkUu Hkh dk;Z fd;k gS ;k dk;Zjr gaS] rks mldk iwjk fooj
...
k
djus
dh fnukad

in NksM +u s
dh fnukad

LFkkbZ @
vLFkkbZ @
la L FkkbZ

osrueku
,Oka
ewy osru

la y Xud
la [ ;k

¼2½ ;fn vki foKkiu ds vuqlkj vf/kdre vk;q lhek esa NwV pkgrs gS] rks izek
...
kZ fooj
...
kZ fooj
...
Mr@inP;qr@CySdfyLV@fooftZr fd;k x;k gks] rks ml ijh{kk dk uke] o"kZ
,oa mlds dkj
...
k

~&% vkosnd }kjk 'kiFk;qDr ?kks"k
...
kk djrk@djrh gw¡ fd bl vkosnu&i= dh lHkh izfof"V;ka o layXu vfHkys[k
esjh O;fDrxr tkudkjh vkSj fo’okl ds vuqlkj lR; ,oa lEiw
...
kk djrk@djrh gw¡ fd esjs fnukad 1&6&02 dks ;k mlds i’pkr~ nks ls vf/kd cPps gaS@ugha
gSaA
*tks ykxw uk gks rks mls dkV nsA
a
LFkku %& ------------------------------------------fnukad %& ----------------------------------------

vkosnd ds iw
...


layXu vfHkys[k fooj
...
Mjh

tkjh Øekad
o fnukad

2
...
ki=& eSfVªd@gkbZ Ldwy@lsd
...


vadi=& gk;j lSd
...
Mjh@bUVjehfM,V

4
...
ki=& gk;j lSd
...
Mjh@bUVjehfM,V

5
...


mikf/k@izek
...


vadi=& vf/kLukrd ¼,e-,@,e-dkWe@,e-,llh-@----------------------------½

8
...
ki=& vf/kLukrd ¼,e-,@,e-dkWe@,e-,llh-@--------------------------½

9
...
ki= &

10
...
ki= &
11
...

13
...

15
...
kh %&
vkosnu i= esa vafdr lwpuk dk layXu vfHkys[kksa dh izfr ls feyku fd;k x;k vkSj lgh ik;k x;k@
fuEu deh ikbZ xbZ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------gLrk{kj
&% f'k{kk lEcU/kh izek
...
kd vgZrk mRrh
...
kr fd;k tkrk gS fd Jh@Jherh@dqekjh------------------------------------------------------iq= Jh---------------------------------------------------------------------fuoklh------------------------------------------------------------------------------------------------------------------------------------------------------tks fd -------------------------------- in ds
fy, foKkiu esa fu/kkZfjr vafre frfFk -------------------------------rd bl in dh visf{kr 'kS{kf
...
kd ;ksX;rk
i vH;FkhZ dh vfuok;Z 'kS{kf
...
kd ;ksX;rk izkIr Fkk ;k mlds ckn
izkIr fd;k gS\
iii ;fn vH;FkhZ vkosnu ds le; vfuok;Z
'kS{kf
...
kZ ugha Fkk] rks D;k
vkosnu dh frfFk rd ml ijh{kk ds vafre
o"kZ ds ikB~;Øe dh ijh{kk esa lfEefyr gks
pqdk Fkk\
iv D;k vH;FkhZ vfuok;Z 'kS{kf
...
kZ gS\
¼lk{kkRdkj dh fLFkfr esa lk{kkRdkj dh
frfFk rd½
v dsoy lk{kkRdkj ds vad ls p;u dh
fLFkfr esa D;k vH;FkhZ vfuok;Z 'kS{kf
...
kZ gS\
2- Js
...
kh esa gh gS ;k mlls fHkUu Js
...
kh dk gS] rks D;k
og vkosnu dh frfFk ls iwoZ viuh vkjf{kr
Js
...
kh dk gS] rks D;k
mlus jktLFkku dk ewy fuoklh gksus dk
lk{; izLrqr fd;k gS\
iv ;fn vH;FkhZ vkjf{kr Js
...
kh esa gksus dk lk{; izLrqr fd;k gS\
3- vuqHko
a
i ;fn ijh{kk esa dksbZ vuqHko lac/kh ;ksX;rk
fu/kkZfjr gS] rks vH;FkhsZ us mldk vtZu
'kS{kf
...
kZ

ijh{kk dh frfFk rd
mRrh
...
kZ

lk{kkRdkj dh frfFk
rd mRrh
...
kh esa

fHkUu Js
...
kd ;ksX;rk
ds mijkUr

'kS{kf
...
kh esa ekurk gS\
&% vf/kdre vk;q lhek esa fofo/k Jsf
...
M vkWfQllZ@'kksVZ lfoZl deh'k
...
k djrs le; ;fn bl in ds
vafdr djsA
a
fy, vk;q lhek esa Fks] rks mUgsa lsuk ls fjgk gksus ds ckn
vk;ksx ds le{k mifLFkfr ds le; vk;q lhek ds vUrxZr gh
le>k tk,xk
12- ,u-lh-lh- dSMsV izf'k{kd ¼bULVªDVlZ½ ds ekeys esa vf/kdre muds }kjk ,ulhlh
vk;q lhek esa ¼;fn ifj
...
Mr gksus ls iwoZ bl jkT; ljdkj ds dksbZ vf/kdre vk;q
v/khu fdlh in ij laLFkkbZ (Substantive) #i ls dk;Z dj
lhek ykxw ugha
pqdk gks vkSj bu fu;eksa ds rgr fu;qfDr ds ;ksX; Fkk
6

161718-

vU; HkwriwoZ dSnh tks nf
...
kd ;ksX;rk gS ¼jkT; ljdkj ds laLFkkbZ deZpkfj;ksa ds
lhek 42 o"kZ
laca/k esa 45 o"kZ ½
dksbZ vU;
vkosnd ds gLrk{kj

uksV %&
1- vk;q laca/kh mDr fu;e lkekU; Lo:i ds gSa] fdlh in ;k ijh{kk fo'ks"k ds fy, vU; fu;e Hkh ykxw gks ldrs
gS]a ftls lac) foLr`r foKfIr esa ns[kk tk ldrk gSA
2- mDr izko/kkuksa esa of
...
kh
¼dk;kZy; mi;ksx gsrq½
vkosnu&i= izkfIr dh vfUre frfFk

dk;kZy; esa vkosnu&izkfIr dh frfFk

vkosnd dh Js
...
kh
dze la-

vkosnd dk esfjV Øekad
fooj
...
kZ izfof"V;ksa lfgr izkIr gqvk gS\
2
D;k gLrk{kfjr nks QksVks fu/kkZfjr LFkku ij fpidk, gq, gSa\
3
D;k vkosnd Hkjh xbZ Js
...
kd ;ksX;rk iwjh dj yh gS\
5
D;k vkosnd okafNr vuqHko iwjk djrk gS\
6
D;k vkosnd fu;ekuqlkj vk;q lhek esa gS\
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...
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7

Attestation Form
(This format will be used for verification by Police Department)
(Please write in block capital letters)

1
...


3
...


5
...

Merit No
...
e
...
Lane / Street, Road, Village, Thana, Tehsil, District)

Village:
District:
PIN
Home Address (in full i
...
House No
...
e
...
Lane / Street, Road, Village, Thana, Tehsil, District)

Father's details:
(a) Name(in full with aliases, if any)
(b) Present postal address
(if dead, give last address)

(c) Permanent Home Address

6
...


8
...


(d) Profession
(e) If in service, give Designation &
Official address
(i) Nationality of: (a) Father
(b) Mother
(c) Husband
(d) Wife
(ii) Place of birth of:
(a) Husband
(b) Wife
(a) Date of birth
(b) Present age as on Advertised
norm
(c) Age at matriculation
(a) Place of birth, District & State in
which it is situated
(b) District & State to which you
belong
...


Indian
Indian
Indian
Indian

Date ------------Month------------------Year----------------------------------Years----------Months --------------Days
-----------------Years----------Months --------------Days
Place of Birth:
District:
State:
District:
State:

10
...

Name of School / College with full address

Date of entering

Date of leaving

Examination passed

1
...
Address:

Village
District
3
...
Address:

Pin:

Village
District
5
...


Pin:

Pin:

Village
District
Pin:
If you have, at any time been employed, give details:
Period
Designation of Post held
or description of work
...


12
...


13
...

1
...


I certify that foregoing information is correct and complete to the best of my knowledge and belief, I am not aware of any
circumstances which might impair my fitness for employment under Government
...

Place
...

Signature of Candidate
____________________________________________________________________________________
(Certificate to be signed by a Gazetted Officer or Member of Legislative Assemble or
other authority prescribed by the Appointing Authority)
Certified that I have known Shri/Smt
...

S/o/Wife/Daughter of Shri
...
years/months and that to
the best of knowledge and belief the particulars furnished by him/her are correct
...

Date
...

Designation or Status & Address
...

Rubber Stamp

---

Title: form no 12
Description: good

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