95 PROSPECTUS 2017-18 ANNEXURE I CERTIFICATE FOR SCHEDULED CASTES/SCHEDULED TRIBES (SC/ST) Despatch No. ______________ Date ___________________ 1. It is certified that Shri/Smt./Kumari________________________________________________ son/daughter of Shri___________________________________________________________ of village/town________________________________________________________________ District/Divison____________________________________________________State of Punjab belongs to __________________________ Caste which has been recognised as Scheduled Caste as per “The Constitution (Scheduled Castes) Order, 1950”. 2. Shri/Smt./Kumari___________________________________and his/her family lives in village/ town______________________________District/Division of Punjab State. Signature_____________________ Place _________________ Designation___________________ Date _________________ (with seal of office) Authorities competent to issue SC/ST Certificate : (i) M.Ps. in respect of Scheduled Caste persons residing in their respective parliamentary constituencies. (ii) M.L.As. in respect of Scheduled Caste persons residing in their respective assembly constituencies. (iii) All gazetted officers of the State Government. (Declared as such vide letter No. 460/WG/56/4799 dated 25-01-1956 and 1/19/94-RCI/6045 dated 15-07-1994). (iv) Tehsildar/Naib Tehsildar (In partial modification of Letter No. 1/8/07-rs 1/1295 dated 2-11-10 issued vide letter no. 1/8/2007-rs 1/1047 dated 16-12-2011 N.B. : In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution.
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ANNEXURE I 17.08.2005, Notification No.1/41/93-RCI/209 dated 24.02.2009 and Notification No.1/41/93-RCI/609 dated 24.10.2013. Date of Issuance Signature of Issuing Authority Designation:
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95prospectus 2017-18
ANNEXURE I
CERTIFICATE FOR SCHEDULED CASTES/SCHEDULED TRIBES (SC/ST)
Despatch No. ______________ Date ___________________
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ANNEXURE II (Form A)
99 punjab agricultural university
ANNEXURE II (Form B)Government of Punjab
Office of the __________________ District ___________
Certificate of Backward Class
CertificateNo.__________
This is to certify that Shri/Smt./Kumari ________________________
Son/Daughter of Shri ________________________
Village ________________________
District/Division ________________________
In theState ofPunjab belongs to the _____________ communitywhich is recognized as backwardclass under theGovernment of Punjab, Department ofWelfare of SCs and BCs vide NotificationNo._______________ dated ________ .
Shri/Smt./Kumari____________and/orhis/herfamilyordinarilyresidesinthe____________District/Division of theState of Punjab.
notapplicable)ofShri________________________________who isa freedomfighter/TamraPatra
holder and/or drawing pension from _____________________ treasury as per PunjabGovt. Rules/
Instructions.
Place _____________ Signature __________________
Date _____________ Designation ________________ (with seal of office)
Authorities competent to issue F/F Certificate : DistrictMagistrate
N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/herself liable for criminal prosecution.
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ANNEXURE IVCERTIFICATE TO BE FURNISHED BY THE CANDIDATE IN SUPPORT OF CLAIM OF BEING CHILD OF
INSERVICE/EX-SERVICE IN ARMED FORCES/C.R.P./B.S.F. OFFICERS/OFFICIALS (INCLUDING OFFICERS /OFFICIALS WHO DIED DURING THEIR SERVICE) CHILDREN//WIDOWS OF PARA-MILITARY FORCES
PERSONNEL, PUNJAB POLICE, PAP AND PUNJAB HOME GUARDS KILLED OR DISABLED IN ACTION TO THE EXTENT OF 50% OR MORE AND WARDS OF PUNJAB POLICEMEN DECORATED
2. It is certified that No.__________Rank_________Name________________________________ isa residentof_________________________Village/Town_____________Tehsil_______________District________________andhasservedin the IndianArmedForces from_______________________ to________________________andhasbeen released/retiredvideorderNo.___________Dated_________ordischargecertificateissuedby_______________________isanex-serviceman.Shri/Smt./Kumari _______________________________ son/daughter/wife of ______________________________ is residingwith him and iswholly dependent upon him.
3. Certified that ____________________ father/mother of ______________________ is/was in service ofArmedForces/CRP/BSF from______ to _____ as ________________________ (designation) and died during service.
This certificatehasbeen issued for admissionpurposeonly toShri/Smt./Kumari _____________________ toapplyfor (name of the class/course) __________________ in (name of the educational Institution) _________________________.
Place ______________ Signature of the_____________________Date ______________ AttestingAuthority___________________ (Seal or stamp of the officer signing the certificate must be affixed here)
Theabovecertificatemaybesignedby theHeadof theunit inwhich the father/motherof thecandidate isserving.In case of ex-serviceman, the certificatemay be signed by theSecretary,District Soldiers, Sailors andAirmenBoard.
CERTIFICATE OF DEATH/INCAPACITATION OF PARA-MILITARY PERSONNEL Certified thatMr./Ms...........................................................................................anapplicant for admission to .........................................................................course in PunjabAgriculturalUniversity,Ludhiana is theson/daughter/spouseofMr./Ms.........................................................................whowaskilled/incapacitated to theextentof 50%ormore inactionordiedotherwise in service on/or incapacitated to the extent of 50%ormorewhile in service during peace time.
Dated.................................................... Signature of AuthorisedOfficerHeadquarter Official Seal
CERTIFICATE OF GALLANTRY AWARD TO POLICE PERSONNEL Certified thatMr./Ms............................................................................................................anapplicant for admissionin.................................................................................................. course inPunjabAgriculturalUniversity, Ludhiana is the son/daughter/spouse of Shri...............................................................................who was awardedPresident’s PoliceMedal/PoliceMedal for gallantry.
Dated............................................ Official Seal Signature of InspectorGeneral of Police
N.B.: In case the certificate is found to be false or incorrect, the candidatewill render himself/herself liable for criminalprosecution.
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ANNEXURE V
CERTIFICATE TO BE ISSUED BY THE SUB-DIVISIONAL OFFICER (CIVIL) IN RESPECT OF INNOCENT CIVILIANS KILLED/100% PHYSICALLY INJURED BY TERRORISTS/SECURITY FORCES
ACTING IN AID OF CIVIL POWER (T.A.) AND ALSO WHO AFFECTED IN NOVEMBER, 1984 RIOTS AND INTERNAL/EXTERNAL MIGRANTS.
1. It is certified thatMr/Mrs______________________________________________ son/daughter/wife ofMr./Ms___________________________________residentof______________________________________(Nameof village, tehsil (in case the deceased belonged to rural area) house number, name ofmohalla and area oftowntowhichhe/shebelongs)waskilled/100%physicallydisabledbytheterrorists/securityforcesactinginaidofcivilpoweron________________________________________________________________inVillage/Mohalla________________________________________Tehsil/Town____________________________________District________________________________.Hewas neither terrorist nor having any linkswith such elements.
(ii) LikewiseifahospitalmentionedinCol3abovedoesnothavetherequisiteassessmentfacilitiesforvariousdisabilities,theheadofsuchhospitalmayutilizethefacilitiesavailableinthehospitaloftheHealthDepartmentinanearbyplaceinthedistrictorreferthecasetotheMedicalCollegesfortestingfacilities.TheMedicalCollegeswheresuchcasescanbereferredare:
S.N.
1
1.
2.
3
Type of Disability
2
Obvious Disability on Form-II (i)LocomotorDisabilitybywayonlyofamputationorcompletepermanent paralysis of limbs.(ii)Blindness
...............................................................................(Signature or left thumb impression of personwithdisability, or of his/her legal guardian in case ofpersonswithmentalretardation,autism,cerebralpalsyandmultipledisabilities)
No. Disability Affected Diagnosis Permanent physical Impairment / part of Body mental disability (In %)
1 Locomotordisability @ 2 Lowvision # 3 Blindness BothEyes 4 Hearingimpairment 5 Mentalretardation X 6 Mental-illness X
(B) Inthelightoftheabove,his/heroverallpermanentphysicalimpairmentasperguidelinesnotifiedbyMinistryofSocialJusticeandEmpowermentNo.16-18/97-NI-I,NewDelhidated1stJune,2001,isasfollows:-Infigures:-................................................................................percentInWords:-.............................................................................................................................................................percent2. Thisconditionisprogressive/non-progressive/likelytoimprove/notlikelytoimprove.3. Reassessmentofdisabilityis– (i)notnecessary, Or (ii)isrecommended/after...............years................months,andthereforethiscertificateshallbevalidtill............./............/................. (DD/MM/YYYY)[email protected]. Left / Right/ both arms / legs-#- e.g. Single eye / both eyes
Nature of Document Date of issue Details of authority issuing certificate
5. SignatureandsealoftheMedicalAuthority.
Nameandsealof Nameandsealof Nameandsealofthe Member Member Chairperson
Signature/ Thumb impression ofthepersonwhosefavourdisabilitycertificateisissued
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ANNEXURE VI (Form-IV)DISABILITY CERTIFICATE (SINGLE DISABILITY)
(In case other than those mentioned in Forms II and III)(NAME AND ADDRESS OF THE HEALTH INSTITUTION)
(See rule 4)
CertificateNo. Date:
This is to certifythatwehavecarefullyexaminedShri/Smt./Kum..................................................................son/wife/daughterofShri.......................................................DateofBirth.............../............./...............Age.....................years,male/female................................... (DD/MM/YYYY)
2. Theaboveconditionisprogressive/non-progressive/likelytoimprove/notlikelytoimprove.3. Reassessmentofdisabilityis– (i)notnecessary, Or (ii)isrecommended/after...............years....................months,andthereforethiscertificateshallbevalidtill............./........../.............. DD/MM/[email protected]. Left / Right /both arms / legs-# - e.g. Single eye / both eyes-- e.g. Left / Right /both ears
CETIFICATE TO BE PRODUCED BY THE CANDIDATE IN SUPPORT OF CLAIM OF TSUNAMI AFFECTED (TSA)
No. __________________ Date __________________
It is certified that Shri/Smt./Kumari ___________________________________________
Son/Daughter of ________________________ Resident of __________________________
Tehsil _____________________District __________________________ is Tsunami affected. He/
She is resident of ______________________________ Tehsil ____________________________
District ____________________________.
Signature ____________________
Designation __________________
(with seal of office)
Authority competent to issue Tsunami affected Certificate :
DistrictMagistrate
NB : IncasetheCertificateisfoundfalseorincorrect,thecandidatewillrenderhimself/herselfliablefor criminal prosecution.
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ANNEXURE IXResidence Certificate
**CERTIFICATE TO BE ISSUED BY THE PRINCIPAL/HEAD MASTER OF THE GOVERNMENT/RECOGNISED SCHOOL/COLLEGE CONCERNED IN CASE OF CATEGORY (b) (i) of Annexure-E
It is certified thatMiss/Mr. __________________________________________________________ D/o/S/oSh.__________________________________________hasbeenastudentofthisSchool/Collegeforaperiodof___________________years,from______________________to___________________.He/She left theSchool/College on _______________________________.
Dated ________________ Signature of Principal/HeadMaster of theSchool/College (with seal)
**CERTIFICATE TO BE ISSUED BY HEAD OF THE DEPARTMENT IN CASE OF CATEGORY (b) (ii) (a) of Annexure-E
Certified thatMr./Ms.________________________S/o/W/o Sh._____________________________ father/motherofMiss/Mr.____________________________________________(nameoftheChild/Ward)isanemployeeofthe________________________________(nameofOffice)ofPunjabGovernment.He/Sheisworkingas____________________________andispostedat__________________________He/She hasmore than three years service at his/her credit.
Date _________________ Head ofDeptt. (Seal)Place _________________
ORCertifiedthatMr./Mrs.___________________________S/o/W/oSh.__________________ is father/motherofMiss/Mr.________________________________isanemployeeofthe_________________of Punjab Government. He/She is working as ______________________________________ondeputationwiththe_________________________andispostedat______________________.He/She hasmore than three years service at his/her credit.
Place ______________ Head of theDepartmentDated ______________ (with seal)
** CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (b) (ii) (b) of Annexure-E
Certified thatMr./Mrs. ___________________________S/o/W/o/Sh. ______________________ isfather/motherofMiss/Mr.____________________________________isanemployeeofGovt.ofIndiaand he/she isworking as ___________________. He/She has been posted atChandigarh/Punjabin connectionwith the affairs of PunjabGovernment for the past three years.
Head of theDepartmentDated ______________ (with seal)
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**CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (b) (ii) (c) of Annexure-E
Certified thatMr./Mrs._____________________________ S/o/W/o/ Sh. _____________________ isfather/motherofMiss/Mr.______________________isanemployeeof__________________(Institution/Undertaking) of theGovernment of Punjab and is working as _____________________________.He/ShehasbeenpostedatChandigarh/Punjab in connectionwith affairs ofPunjabGovernment forperiod of past three years.
**CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (b) (ii) (d) of Annexure-E
CertifiedthatMr./Mrs.___________________________S/o/W/o/Sh.____________________isfather/motherofMiss/Mr._____________________________________________________isanemployeeof______________________.(nameofautonomousbody/company)_____________________________inwhichthePunjabGovernmenthas20%ormoreshare.He/Sheisworkingas________________________and ispostedat__________________ It isalsocertified thathe/shehas threeyearsservice in theabove said autonomous body/company.
**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC(R ), ADC (D), SDM, ASSTT. COMMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS
OF MUNICIPAL CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN CASE OF CATEGORIES (iv) of Annexure-E
Certified thatMr./Mrs. _______________________________________________________________ S/o/W/o Sh. _________________________________________________________ father/mother/guardian ofMr./Miss ____________________________ (name of theChild/Wardwith full address)has settled* in Punjab or has resided* in Punjab for a period of 5 years from ______________________________________ to _________________________.He/She isworking as _______________________________.
*Strike outwhichever is not applicable. (name of profession, designation and job). Dated _______________
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**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC (R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS OF MUNICIPAL
CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN CASE OF CATEGORY (v) of Annexure-E
CertifiedthatMr./Mrs.__________________________________________________________S/o/W/oSh. _____________________________________________________ father/mother/guardian ofMr./Miss.___________________________ (name of theChild/Wardwith full address) hold immovableproperty at (place& district) ____________________________________ in the state of Punjab forthe past ______________________ years.
Dated _______________
**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC (R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS
OF MUNICIPAL CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN THE CASE OF CATEGORIES (vi) of Annexure-E
CertifiedthatMiss/Mr.______________________________S/o/D/o/Sh.____________________________resident of ________________________________was born inPunjab as per BirthCertificate.
Dated _______________
* This affidavit is to be givenby all candidates.** Any one of these certificates, as applicable to the candidate according to the PunjabGovt.
instructions, is to be given.
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ANNEXURE - IX (‘D’)
d&qr qihsIldwr
rYzIfYNs srtIiPkyt
qsdIk kIqw jWdw hY ik SRI / SRImqI / kumwrI _______________________________
puqr/puqrI/pqnI SRI _________________________________, vwsI__________________
Tehsil_____________________________ District ________________________________ holds
immovable property in theState of Punjab.
Tehsildar_____________________
No. ____________________
Date: ___________________
ANNEXURE - IX (‘F’)
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ANNEXURE X
CERTIFICATE BY THE HEAD OF SECTION/DEPARTMENT/OFFICE FOR INSERVICE CANDIDATES OF THE PUNJAB AGRICULTURAL UNIVERSITY AND PUNJAB GOVT. AND UNION TERRITORY OF
CHANDIGARH ONLY
1. Certified that Shri/Smt./Kumari_______________________________________________is