सल कोफिफड्स लिटेड / CENTRAL COALFIELDS LIMITED (कोल इडिया की एक सहायक कपनी)/ (A Subsidiary of Coal India Limited) ििरि कपिी/A Miniratna Company दरभ ं गा हाउस, राची/Darbhanga House Ranchi नोट: शद-संेप: अ॰जा॰-अनुसूचित जातत; अ॰ज॰जा॰-अनुसूचित जन जातत; Note: Abbreviations: UR-Unreserved, OBC-Other Backward Class, NCL-Non-Creamy Layer, SC-Scheduled Caste, ST-Scheduled Tribe संदभ संया: सीसीएल/ी/िापन/032016/04 दनांक: 28/03/2016 Ref.No:CCL/Recruitment/Adv/032016/04 Dated: 28/03/2016 रोज़गार स ू चिा / EMPLOYMENT NOTICE सेरल कोलफीि्स लिटे ि, देश के ऊाभ े िएक िनी रन कपनी, ननलि पद की ररिय को रने के लए ार के नागररक से आिेदन आिं करी है : Central Coalfields Limited, a Mini Ratna Company in energy sector of the country, invites applications from Indian nationals for filling of the vacancies in following posts: / S N पद का िाि/ Name of Post ेड/ Grade िूल वेति/ Basic (In Rs.) अिारि त/ UR अय पछड़ा वगग(िॉि ीिी लेयर) OBC/ (NCL) आ. ज/ SC आ. ज.जा. ST कु ल/ Sub total Backlog कु ल Total अय पछड़ा वगग(िॉि ीिी लेयर) OBC (NCL) आ. ज SC आ. ज.जा. ST 1 ूनयर ओिरिैन Junior Overman क॰ एिं सु॰ ेि सी T & S Gr. C 19035.02 50 12 12 26 100 -- -- 48 148 2 िाईनंग सरदार Mining Sirdar क॰ एिं सु॰ ेि सी T & S Gr. C 19035.02 87 20 20 44 171 03 44 131 349 3 िे युटी सिेयर Deputy Surveyor क॰ एिं सु॰ ेि सी T & S Gr. C 19035.02 14 3 3 7 27 -- -- 13 40 4 असटट फोरिैन (इलैररकल) Assistant Foreman (Electrical) क॰ एिं सु॰ े ि सी T & S Grade C 19035.02 27 6 6 13 52 07 20 64 143 5 इलेररशयन (नॉन-एरसकिेशन) /कनीशयन Electrician(Non- Excv.) /Technician (DR) Cat-IV 649.69 दन/ per day 25 6 6 13 50 29 37 82 198 सी उपरोि पद के लए िेन और े , रारीय कोयला िद ू री सिझौा-IX (एन.सी.ियू.ए.-IX) के अनुसार िीकायभ कए ाएग। उपरोि पद के लए िाषभक िृि िूल का 3%, अय े, िाषभक अिकाश, आकिक अिकाश, िकसा अिकाश, SDA, VDA, उपदान, िय नि & पशन कं पनी के नयि के अनुसार के ुगान कया ाएगा, था िकसा ा (ियि एिं आि पररिार के सदय के लये), िाहन पूभ , आिास कराया ा (यद कपनी ारा रिाटर आिंटन नह कया गया हो), कंपनी के िानदंि के अनुसार दान की ाएगी। For all the above posts, the pay and allowances will be admissible as per National Coal Wage Agreement (NCWA)-IX. The above posts will carry an annual increment @ 3% of basic pay on progressive basis along with other allowances & benefits such as Annual Leave, Casual leave, Sick leave, SDA, VDA, Gratuity, Provident Fund & Pension as per Company’s Rule, Free medical facilities (for self & dependent family members), Conveyance Reimbursement, House Rent Allowance (in case Quarter is not provided) as per company’s norms. ियन अयथी सी. सी. एल. के कसी ी े/इकाई/पररयोना िनयुि कये ा सके ह। The selected candidates can be posted in any Area/Unit/ Project of CCL.
40
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ोज़गा सoचिा / EMPLOYMENT NOTICE · ण्लए प्रण्शक्षण िें हेंगे। एक िषभ के प्रण्शक्षण
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Transcript
सटरल कोलफिफडस लललिटड CENTRAL COALFIELDS LIMITED
(कोल इणडिया की एक सहायक कमपनी) (A Subsidiary of Coal India Limited)
लिलिरति कमपिीA Miniratna Company
दरभगा हाउस रााचीDarbhanga House Ranchi
नोट शबद-सकषप अजा-अनसचित जातत अजजा-अनसचित जन जातत
Note Abbreviations UR-Unreserved OBC-Other Backward Class NCL-Non-Creamy Layer SC-Scheduled Caste ST-Scheduled Tribe
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरट-आउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
12
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
13
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner etc
Dated Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 रर गए आिदन पतर सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा सपीि पोसट दवारा पराणपत की
अणरति णरतणथ 16052016
25
Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
26
Annexure B
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy ommissioneretc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
THE FORM OF CERTIFICATE TO BE PRODUCED BY PHYSICALLY HANDICAPPED CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
NAME amp ADDRESS OF THE INSTITUTEHOSPITAL
Certificate No Date
DISABILITY CERTIFICATE This is certified that ShriSmtKum sonwifedaughter of Shri age sex identification
mark(s) is suffering from permanent disability of following category
A Locomotor or Cerebral Palsy
(i) BL-Both legs affected but not arms
(ii) BA-Both arms affected (a) Impaired reach
(b) Weakness of grip
(iii) BLA-Both legs and both arms affected
(iv) OL-One leg affected (right or left) (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(v) OA-One arm affected (a) Impaired reach
(b) Weakness of grip
(c) Ataxic
(vi) BH-Stiff back and hips (cannot sit or stoop)
(vii) MW-Muscular weakness and limited physical endurance
B Blindness or Low Vision
(i) B-Blind
(ii) PB-Partially blind
C Hearing impairment
(i) D-Deaf
(ii) PD-Partially deaf
(Delete the category whichever is not applicable)
2 This condition is progressivenon-progressivelikely to improvenot likely to improve Re-assessment of this case is not recommendedis
recommended after a period of years months
3 Percentage of disability in hisher case is Percent
4 ShriSmtKum meets the following physical requirements for discharge of hisher duties-
(i) F-Can perform work by manipulating with fingers YesNo
(ii) PP-Can perform work by pulling and pushing YesNo
(iii) L-Can perform work by lifting YesNo
(iv) KC-Can perform work by kneeling and crouching YesNo
(v) B-Can perform work by bending YesNo
(vi) S-Can perform work by sitting YesNo
(vii) ST-Can perform work by standing YesNo
(viii) W-Can perform work by walking YesNo
(ix) SE-Can perform work by seeing YesNo
(x) H-Can perform work by hearingspeaking YesNo
(xi) RW-Can perform work by reading and writing YesNo
(Dr) (Dr) (Dr )
Member Medical Board Member Medical Board Chairman Medical Board
Countersigned by the Medical
SuperintendentCMOHead of Hospital(With
seal)
Strike out whichever is not applicable
Recent Photograph of the candidate showing the disability duly attested by the Chairperson of the Medical Board
28
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
Annexure D CERTIFICATE TO BE PRODUCED BY EX SERVICEMAN
Form A Form of Certificate applicable for ReleasedRetired Personnel
It is certified that No Rank Name whose date of birth is has rendered service from to in
ArmyNavyAir Force
2 He has been released from military services
a) on completion of assignment otherwise than
(i) by way of dismissal or
(ii) by way of discharge on account of misconduct or inefficiency or
(iii) on his own request but without earning his pension or
(iv) he has not been transferred to the reserve pending such release
b) on account of physical disability attributable to Military Service
c) on invalidment after putting in at least five years of Military service
3 He is covered under the definition of Ex-Serviceman (Re-employment in Central Civil Services and Posts) Rules 1979 as amended from time
to time
Place
Date Signature Name and Designation of the Competent uthority
SEAL
Delete the paragraph which is not applicable
Form B Form of Certificate for Serving Personnel
(Applicable for serving personnel who are due to be released within one year)
It is certified that No helliphelliphelliphelliphellipRankhelliphelliphellipNamehelliphelliphellip is serving in the ArmyNavyAir Force fromhelliphelliphelliphelliphelliphelliphelliphellip
2 He is due for release retirement on completion of his specific period of assignment on
3 No disciplinary case is pending against him
Place Signature Name and Designation of the
Date Competent Authority
SEAL
Candidate (Serving Personnel) furnishing certificate B as above will have to give the following undertaking
Form C Undertaking to be given by serving Armed Force personnel who are due to be released within one year
1 I understand that if selected on the basis of the recruitmentExamination to which this application relates my appointment will be subject to
my producing documentary evidence to the satisfaction of the appointing authority that I have been duly releasedretireddischarged from the
Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Reemployment in Central Civil
Service and Posts) Rules 1979 as amended from time to time
2 I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-serviceman in regard to the recruitment covered by
this examination if I have at any time prior to such appointment secured any employment on the civil side (including Public Sector
Undertaking Autonomous BodiesStatutory Bodies Nationalised Banks etc) by availing of the concession of reservation of vacancies
admissible to Ex-serviceman
Place
Date Signature and Name of Candidate
Form D Form of Certificate applicable for Serving ECOsSSCOs who have already completed their initial assignment and are on
extended assignment It is certified that No Rank Namewhose date of birth is is serving in the ArmyNavyAir
Force from
2 He has already completed his initial assignment of five years onhelliphelliphelliphelliphellipand is on extended assignment tillhelliphelliphelliphelliphelliphellip
3 There is no objection to his applying for civil employment and he will be released on three months notice on selection from the date of receipt
of offer of appointment
Place
Date Signature Name and Designation of the Competent AuthoritySEAL
Authorities who are competent to issue certificate to Armed Forces Personnel for availing Age concessions are as follows
(a) In case of Commissioned Officers including ECOsSSCOs
Army - Military Secretary Branch Army Hqrs New Delhi
Navy - Directorate of Personnel Naval Hqrs New Delhi
Air Force - Directorate of Personnel Officers Air Hqrs New Delhi
(b) In case of JCOsORs and equivalent of the Navy and Air Force
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
3 ऑनलाइन रर गए आिदन का णपरटआउट सरी परासणगक दसरतािरो साथ अणििानरतः सािानटयरतः परीकरत िाक अथिा
सपीि पोसट दवारा पराणपत की अणरति णरतणथ 16052016
39
अिलगिक Annexure A
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED
TRIBE CANDIDATE APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
1 This is to certify that ShriShrimatiKumari sondaughter of of
villagetown in DistrictDivision of the StateUnion Territory belongs to
the CasteTribe which is recognised as a Scheduled CasteScheduled Tribe under-
The Constitution (Scheduled Castes) Order 1950
The Constitution (Scheduled Tribes) Order 1950
The Constitution (Scheduled Castes) Union Territories Order 1951
The Constitution (Scheduled Tribes) Union Territories Order 1951
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order 1956 the Bombay Reorganisation Act 1960 the Punjab
Reorganisation Act 1966 the State of Himachal Pradesh Act 1970 the North Eastern Areas (Reorganisation) Act 1971 the Scheduled Castes
and Scheduled Tribes Order (Amendment) Act 1976 the State of Mizoram Act 1986 the State of Arunachal Pradesh Act 1986 and the Goa
Daman and Diu (Reorganisation) Act 1987]
The Constitution (Jammu and Kashmir) Scheduled Castes Order 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order 1959 as amended by the Scheduled Castes and Scheduled Tribes
Order (Amendment) Act 1976
The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order 1962
The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order 1962
The Constitution (Pondicherry) Scheduled Castes Order 1964
The Constitution (Uttar Pradesh) Scheduled Tribes Order 1967
The Constitution (Goa Daman and Diu) Scheduled Castes Order 1968
The Constitution (Goa Daman and Diu) Scheduled Tribes Order 1968
The Constitution (Nagaland) Scheduled Tribes Order 1970
The Constitution (Sikkim) Scheduled Castes Order 1978
The Constitution (Sikkim) Scheduled Tribes Order 1978
The Constitution (Jammu amp Kashmir) Scheduled Tribes Order 1989
The Constitution (SC) Order (Amendment) Act 1990
The Constitution (ST) Order (Amendment) Act 1991
The Constitution (ST) Order (Second Amendment) Act 1991
The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Order (Amendment) Act 2002
The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act 2002
The Constitution (Scheduled Castes) Orders (Second Amendment) Act 2002
2 Applicable in the case of Scheduled CastesScheduled Tribes persons who have migrated from one StateUnion Territory Administration to
another
This certificate is issued on the basis of the Scheduled Castes Scheduled Tribes Certificate issued to Shri Smt
Kumarihelliphelliphelliphelliphelliphelliphelliphelliphellip helliphelliphelliphelliphelliphelliphelliphelliphelliphellipFather Mother of Sri Smt Kumari helliphelliphelliphelliphelliphelliphellipof village
townhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipin DistrictDivisionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip of the StateUnion
Territoryhelliphelliphelliphelliphelliphelliphelliphelliphellip who belong to thehelliphelliphelliphelliphelliphellipCaste Tribe which is recognized as a Scheduled CasteScheduled Tribe in
the StateUnion Territory issued by the helliphellip[Name of the authority] vide their No helliphelliphelliphelliphelliphelliphelliphellip dated helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip
3 ShriShrimatiKumari andor hisher family ordinarily resides in villagetown
ofDistrictDivision of the StateUnion Territory of
Place
Signature
Date
Designation
(With Seal of Office)
StateUnion Territory
Please delete the words which are not applicable
Please quote specific Presidential Order
Delete the paragraph which is not applicable
NOTE The term ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue Scheduled CasteScheduled Tribe Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy Commissioner Additional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka MagistrateExecutive Magistrate Extra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
40
अिलगिक Annexure B1
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWAD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that ShriSmtKumari_______________________________________________________sondaughter of
______________________________________________________________ of villagetown _______________________ in DistrictDivision
_______________________________________________________________in the StateUnion Territory
________________________________________________belongs to the _____________________________community which is recognized as
a backward class under the Government of India Ministry of Social Justice and Empowermentrsquos Resolution of
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013
__________________________________________________ and hisher family ordinarily reside (s) in the
_________________DistrictDivision of the __________________________________StateUnion Territory This is also to certify that heshe
does not belong to the personssections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India Department of
Personnel amp Training OM No 360122293-Estt (SCT) dated 891993
District Magistrate
Deputy Commissioner
etc
Dated
Seal
- The authority issuing the certificate may have to mention the details of Resolution of the Government of India in which the caste of the
candidate is mentioned as OBC
-As amended from time to time
Note- The term ldquoOrdinarilyrdquoused here will have the same meaning as in Section 20 of the Representation of the People Act 1950
List of authorities empowered to issue OBC Certificate
(i) District MagistrateAdditional District MagistrateCollectorDeputy CommissionerAdditional Deputy CommissionerDeputy Collector1st
Class Stipendiary Magistratedagger Sub-Divisional MagistrateTaluka Magistrate Executive MagistrateExtra Assistant Commissioner
dagger(not below of the rank of 1st Class Stipendiary Magistrate)
(ii) Chief Presidency MagistrateAdditional Chief Presidency MagistratePresidency Magistrate
(iii) Revenue Officers not below the rank of Tehsildar
(iv) Sub Divisional Officer of the area where the candidate andor hisher family normally resides
(v) AdministratorSecretary to AdministratorDevelopment Officer (Lakshadweep)
Note 1 Candidates claiming to belong to OBCs should note that the name of their Caste (including its spellings) as indicated in their certificates
should be exactly the same as published in the lists notified by the Central Government from time to time A certificate containing any variation
in the Caste name will not be accepted
Note 2 The OBC claim of a candidate will be determined in relation to the State (or part of the State) to which hisher father originally belongs
A candidate who has migrated from one State (or part of the State) to another should therefore produce an OBC certificate which should have
been issued to himher based on hisher fathers OBC certificate from the State to which he (father) originally belongs
Note 3 No change in the community status already indicated by a candidate in hisher simplified application form for this examination will
ordinarily be allowed by the Commission
अिलगिकAnnexure B2
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE (IN ADDITION TO THE COMMUNITY CERTIFICATE)
I helliphelliphellip Sondaughter of Shrihelliphelliphellipresident of villagetowncity helliphelliphelliphelliphelliphelliphellipdistricthelliphelliphelliphellipstatehelliphelliphelliphereby declare that I belong to
thehelliphelliphelliphelliphelliphellipcommunity which is recognized as a backward class by the Government of India for the purpose of reservation in services as
per orders contained in Department of Personnel and Training Office Memorandum No 361022293-Estt (SCT) dated 8-9-1993 It is also
declared that as on closing date I do not belong to personssections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred
Office Memorandum dated 8-9-1993 OM No 3603332004-Estt (Res) dated 9th March 2004 and OM No 3603332004-Estt (Res) dated
14th October 2008 and OM No 3603312013-Estt(Res) dated 27052013