ãä•ãÔã‡ãñŠ ´ãÀã ãä¶ã½¶ãã¶ãìÔããÀ ¾ãÖ ÔÌããè‡ãŠãÀ ãä‡ãŠ¾ãã •ãã¦ãã Öõ ãä‡ãŠ:-

1. ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠ½¹ã¶ããè ½ãò †‡ãŠ ÌãÓãà ‡ãŠãè ‚ãÌããä£ã ¦ã‡ãŠ ¹ãÆãäÍãàã¥ã ¹ãÀ ÀÖñØãã, ãä•ãÔãñ ‡ãŠ½¹ã¶ããè ‡ãŠãè ƒÞœã Ôãñ ºãü¤ã¾ãã •ãã Ôã‡ãŠ¦ãã Öõ
‚ããõÀ ƒÔã ªãõÀã¶ã ¹ãÆãäÍãàã¥ãã©ããê ½ãñÖ¶ã¦ã, ãäÌãÍÌããÔã ‚ããõÀ ‚ã¹ã¶ããè ÑãñÓŸ ¾ããñؾã¦ãã ‡ãñŠ ‚ã¶ãìÔããÀ ¹ãÆãäÍãàã¥ã ¹ãÆ㹦㠇ãŠÀñØãã ‚ããõÀ
̾ãÌãÖãÀ ‡ãŠÀñØãã ¦ã©ã㠇㊽¹ã¶ããè ‡ãñŠ ¹ãÆãä¦ã ƒÃ½ãã¶ãªãÀãè ãä¶ã¾ããä½ã¦ã ¹ã Ôãñ ‚ããõÀ ‚ãã—ãã‡ãŠãÀãè ¹㠽ãò ‡ãŠã½ã ‡ãŠÀñØãã ‚ããõÀ ‚ã¹ã¶ãã
ÔããÀã Ôã½ã¾ã ¶ããõ‡ãŠÀãè ‡ãñŠ ªããä¾ã¦Ìããò ‡ãŠãñ Ôã½ããä¹ãæ㠇ãŠÀñØãã ‚ããõÀ ¹ãƦ¾ãàã ¾ãã ¹ãÀãñàã ¹ã Ôãñ ‚㶾㠇ãŠãñƒÃ ‡ãŠãÀãñºããÀ, ̾ãã¹ããÀ ¾ãã
̾ãÌãÔãã¾ã ¶ãÖãé ‡ãŠÀñØããý

2. Ôã¹ãŠÊã¦ãã¹ãîÌãÇ㊠¹ãÆãäÍãàã¥ã ¹ãîÀã ‡ãŠÀ¶ãñ ¹ãÀ ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ ‡ãŠ½¹ã¶ããè ‡ãŠãè ¶ããõ‡ãŠÀãè ÔÌããè‡ãŠãÀ ‡ãŠÀ¶ããè ÖãñØããè ‚ããõÀ „Ôã‡ãñŠ ºããª
¦ããè¶ã ÌãÓãà ¦ã‡ãŠ ‡ãŠ½¹ã¶ããè ¾ãã „Ôã‡ãŠãè ƒÞœã ¹ãÀ ¼ããÀ¦ã ÔãÀ‡ãŠãÀ ‡ãñŠ ‚㶾ã ãä‡ãŠÔããè ãäÌã¼ããØã ¾ãã ‚ããõ²ããñãäØã‡ãŠ „¹ã‰ãŠ½ã ½ãò ¦ãºã ¦ã‡ãŠ
¶ããõ‡ãŠÀãè ‡ãŠÀ¶ããè ÖãñØããè, •ãºã ¦ã‡ãŠ ‡ãŠ½¹ã¶ããè ´ãÀã „Ôã ‚ãÌããä£ã Ôãñ ¹ãÖÊãñ ÔãñÌãã†â Ôã½ã㹦㠶ãÖãé ‡ãŠãè •ãã¦ããèý

3. ‡ãñŠÌãÊã ŒãÀãºã ÔÌããÔ©¾ã ‡ãñŠ ‡ãŠãÀ¥ã ‡ãŠãñ œãñü¡‡ãŠÀ, •ããñ „Ôã‡ãŠãè ‚ã¹ã¶ããè Êãã¹ãÀÌããÖãè ¾ãã ªìÀãÞãÀ¥ã ‡ãñŠ ‡ãŠãÀ¥ã ¶ãÖãé Öõ ‚ããõÀ
ãä•ãÔã‡ãñŠ ãäÊㆠ‡ãŠ½¹ã¶ããè ´ãÀã ½ã¶ããñ¶ããè¦ã ãäÞããä‡ãŠ¦Ôãã ‚ããä£ã‡ãŠãÀãè ‡ãŠã ¹ãƽãã¥ã¹ã¨ã ãä¶ã¥ããþã‡ãŠ ‚ããõÀ ½ã㶾ã ÖñãØãã, ¹ãÆãäÍãàã¥ãã©ããê
ãä¶ããäªÃÓ› ¾ãã ºãü¤ã¾ããè ØãƒÃ ‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ¹ãÆãäÍãàã¥ã ¾ãã …¹ãÀ ºã¦ãã¾ããè Øã¾ããè ¦ããè¶ã ÌãÓãà ‡ãŠãè ‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ‡ãŠ½¹ã¶ããè ‡ãŠãè
ÔãñÌãã ¶ãÖãé œãñü¡ñØããý

4. ¹ãÆãäÍãàã¥ãã©ããê ÖÀ Ôã½ã¾ã ‚ããõÀ Ôã½ã¾ã-Ôã½ã¾ã ¹ãÀ ¦ã¦¹ãÀ¦ãã Ôãñ ‚ã¹ã¶ãñ ‡ãŠã¾ãà ‡ãŠÀñØãã ‚ããõÀ ‡ãŠ½¹ã¶ããè ‡ãñŠ Ôã¼ããè ãä¶ã¾ã½ããò ‚ããõÀ
ãäÌããä¶ã¾ã½ããò ‡ãŠã ¹ããÊã¶ã ‡ãŠÀñØããý ¾ãÖ ‚ããä£ã‡ãðŠ¦ã ̾ããä‡ã‹¦ã¾ããò ‡ãñŠ ‚ããªñÍããò ‚ããõÀ ãäÖªã¾ã¦ããò ‡ãŠã ¼ããè ¹ããÊã¶ã ‡ãŠÀñØããý

5. ¹ãÆãäÍãàã¥ãã©ããê ‚ã¹ã¶ãñ ¹ãÆãäÍãàã¥ã Àãñ•ãØããÀ ‡ãñŠ ªãõÀã¶ã ¹ã¦ãã ÞãÊã¶ãñ ÌããÊããè „Ôã‡ãñŠ ‡ãŠã¾ãà ¾ãã ØãÆãÖ‡ãŠãò Ôãñ Ôãâºãâãä£ã¦ã ‡ãŠãñƒÃ ¼ããè
Øããñ¹ã¶ããè¾ã ºãã¦ãò, ¦ã‡ãŠ¶ããè‡ãŠãè •ãã¶ã‡ãŠãÀãè ¾ã㠂㶾㠇ãŠãñƒÃ •ãã¶ã‡ãŠãÀãè ãä‡ãŠÔããè ¼ããè ¦ãÀÖ ãä‡ãŠÔããè ̾ããä‡ã‹¦ã ‡ãŠãñ ¶ãÖãé ºã¦ãã†Øããý

6. ¹ãÆãäÍãàã¥ãã©ããê „‡ã‹¦ã ‡ãŠ½¹ã¶ããè ‡ãŠãè Ôã½¹ããä§ã ¾ãã Þããè•ããò ‡ãŠãñ ºãñ‡ãŠãÀ, ŒãÀãºã ¶ãÖãé ‡ãŠÀñØãã ‚ããõÀ ¶ã Öãè „¶Öò ¶ãì‡ãŠÔãã¶ã ¹ãÖìâÞãã¾ãñØãã
‚ã©ãÌãã „‡ã‹¦ã ‡ãŠ½¹ã¶ããè ‡ãŠãè Ôã½¹ããä§ã ¾ãã Þããè•ããò ‡ãŠãñ „£ããÀ ¶ãÖãé ªñØãã ‚ã©ãÌã㠇㊽¹ã¶ããè ‡ãŠãè ÔãÖ½ããä¦ã ‡ãñŠ ãäºã¶ãã ãä‡ãŠÔããè ̾ããä‡ã‹¦ã ‡ãŠãñ
„£ããÀ ¶ãÖãé ªñØããý

7. ¹ãÆãäÍãàã¥ãã©ããê ãä‡ãŠÔããè ½ã•ãªîÀ ¾ãã Àã•ã¶ããèãä¦ã‡ãŠ Øããä¦ããäÌããä£ã ½ãò ¼ããØã ¶ãÖãé ÊãñØãã ‚ã©ãÌãã ãä‡ãŠÔããè ½ã•ãªîÀ ¾ãã Àã•ã¶ãõãä¦ã‡ãŠ ÔãâØ㟶ã
‡ãŠã ÔãªÔ¾ã ¶ãÖãé ºã¶ãñØããý

8. ¾ããäª ¹ãÆãäÍãàã¥ãã©ããê ‚ã¹ã¶ãã ¹ãÆãäÍãàã¥ã ¹ãîÀã ¶ãÖãé ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè/‚ã©ãÌãã ¹ãÆãäÍãàã¥ã Ôã¹ãŠÊã¦ãã¹ãîÌãÇ㊠¹ãîÀã ‡ãŠÀ Êãñ¶ãñ ‡ãñŠ ¦ãìÀ¶¦ã ºããª
‡ãŠ½¹ã¶ããè ‡ãŠãè ¶ããõ‡ãŠÀãè ¶ãÖãé ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè ¦ããñ „Ôãñ ‚ã¹ã¶ãñ ¹ãÆãäÍãàã¥ã ‡ãñŠ Ôãâºãâ£ã ½ãò ‡ãŠ½¹ã¶ããè ´ãÀ „Ÿã¾ãñ Øã¾ãñ ̾ã¾ã ‡ãŠãñ ƒÔã½ãò
ºã¦ãㆠ‚ã¶ãìÔããÀ ½ãì‚ããÌã•ãã ªñ¶ãã ÖãñØããý ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹ãÆãäÍãàã¥ã ‡ãñŠ Ôãâºãâ£ã ½ãò ‡ãŠ½¹ã¶ããè ´ãÀã „Ÿã† Øㆠ̾ã¾ã ¹ãÆãäÍãàã¥ã
‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ªãè ØãƒÃ ¹ããäÀÊãã亣ã¾ããâ, ¹ã¾ãÃÌãñàã¥ã ‚ããõÀ ‚㶾ã Þããè•ããò ‡ãŠãè ÊããØã¦ã ‚ãããäª Íãããä½ãÊã Öõý ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ
¹ãÆãäÍãàã¥ã ¹ãÀ ‡ãŠ½¹ã¶ããè ´ãÀã ŒãÞãà ãä‡ãŠ† Øㆠ‡ãìŠÊã ̾ã¾ã ‡ãŠã ‚ãâãä¦ã½ã ãä¶ã¥ãþ㠇㊽¹ã¶ããè ‡ãñŠ ‡ãŠã¾ãÇãŠãÀãè ãä¶ãªñÍã‡ãŠ/½ãÖã¹ãƺãâ£ã‡ãŠ ¾ãã
ƒ¶ã‡ãñŠ ´ãÀã ½ã¶ããñ¶ããè¦ã ‚ããä£ã‡ãŠãÀãè ‡ãŠã ÖãñØããý ãä¹ãŠÀ ¼ããè ÌãÔãîÊããè •ãã¶ãñ ÌããÊããè ‡ãìŠÊã À‡ãŠ½ã ¹ãÞããÔã Ö•ããÀ Á¹ã† Ôãñ ‚ããä£ã‡ãŠ ¶ãÖãé
ÖãñØããèý

9. ¹ãÆãäÍãàã¥ã ‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ‡ãŠ½¹ã¶ããè ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ............................Á¹ã† ‡ãñŠ Ìãñ¦ã¶ã½ãã¶ã ½ãò ¶¾ãî¶ã¦ã½ã Ìãñ¦ã¶ã
‚ããõÀ ‡ãŠ½¹ã¶ããè ãä¶ã¾ã½ããò ‡ãñŠ ‚ã¶ãìÔããÀ ‚㶾㠼ã§ãñ •ãõÔãñ- ½ãâÖØããƒÃ ¼ã§ãã ªñØããèý ‚ãã¹ã ‚ã¹ã¶ãñ ½ãîÊã Ìãñ¦ã¶ã ‡ãñŠ 46% ¦ã‡ãŠ
'‡ãõŠ¹ãñŠ›ñãäÀ¾ãã' ¹ã‡ã‹Ôãà ‡ãñŠ ãäÊㆠ¼ããè և㊪ãÀ ÖãòØãñý

10. ¹ãÆãäÍãàã¥ãã©ããê ´ãÀã ƒÔã ¹ãÆÔ¦ããÌã ½ãò ã䪆 Øㆠ¾ãã ¹ãÆãäÍãàã¥ã ¾ããñ•ã¶ãã ‡ãñŠ ãä‡ãŠÔããè ãä¶ã¾ã½ã ¾ãã Íã¦ãà ‡ãŠã ‚ããõÀ ¾ãã „Ôã Ôã½ã¾ã ÊããØãî
‡ãŠ½¹ã¶ããè ‡ãñŠ ãä‡ãŠÔããè ãä¶ã¾ã½ã ‚ããõÀ ãäÌããä¶ã¾ã½ã ‡ãŠã „ÊÊãâÜã¶ã ‡ãŠÀ¶ãñ ‚ããõÀ/¾ãã †ñÔããè ºããè½ããÀãè ‡ãñŠ œì¹ãã¶ãñ ¹ãÀ ãä•ãÔãÔãñ ¹ãÆãäÍãàã¥ãã©ããê
‡ãñŠ

¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ÖÔ¦ããàãÀ

Ñããè/ÔãìÑããè.........................................................Ôãì¹ãì¨ã/Ôãì¹ãì¨ããè...............................................ãä¶ãÌããÔããè
.................................................................(‚ãºã ƒÔã‡ãñŠ ºã㪠Ôãñ "¹ãÆãäÍãàã¥ãã©ããê" ‡ãŠÖã •ãã†Øãã) ¶ãñ ‡ãŠ½¹ã¶ããè ½ãò
¹ã¾ãÃÌãñàã‡ãŠ ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹ãª ‡ãñŠ ãäÊㆠ‚ããÌãñª¶ã ãä‡ãŠ¾ãã Öõý

‚ããõÀ ‡ãŠ½¹ã¶ããè ¶ãñ „¶Öò Þãì¶ã ãäÊã¾ãã Öõ ‚ããõÀ ¹ã¨ã Ôã⌾ãã............................ã䪶ããâ‡ãŠ.....................½ãò ãä¶ããäªÃÓ› ãä¶ã¾ã½ããò ‚ããõÀ
Íã¦ããô ¹ãÀ ‡ãŠ½¹ã¶ããè ½ãò ¹ã¾ãÃÌãñàã‡ãŠ ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹㠽ãò ãä¶ã¾ãìãä‡ã‹¦ã ¹ãÆÔ¦ããÌã ¼ãñ•ãã Öõý

‚ããõÀ ‡ãŠ½¹ã¶ããè ‚ã¹ã¶ããè ¶ããèãä¦ã ‡ãñŠ ‚ã¶ãìÔããÀ ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ †‡ãŠ ÌãÓãà ‡ãŠã ¹ãÆãäÍãàã¥ã ªñ¦ããè Öõ ‚ããõÀ ¹ãÆãäÍãàã¥ã ‡ãñŠ Ôã¹ãŠÊã¦ãã¹ãîÌãÇ㊠¹ãîÀã Öãñ •ãã¶ãñ ¹ãÀ
¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ ‡ãŠ½¹ã¶ããè ½ãò................Á. ‡ãñŠ Ìãñ¦ã¶ã½ãã¶ã ½ãò ÔãÖã¾ã‡ãŠ ‚ããä£ã‡ãŠãÀãè, ØãÆñ¡-II ‡ãñŠ ¹㠽ãò Íãããä½ãÊã ‡ãŠÀ ãäÊã¾ãã •ãã†Øãã ‚ããõÀ
„Ô㠹㪠¹ãÀ „Ôãñ ‡ãŠ½¹ã¶ããè ½ãò ¦ããè¶ã ÌãÓãà ¦ã‡ãŠ ¶ããõ‡ãŠÀãè ‡ãŠÀ¶ããè ÖãñØããèý

‚ããõÀ ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ ‡ãŠ½¹ã¶ããè ‡ãñŠ ¶ãã½ã †‡ãŠ •ã½ãã¶ã¦ããè ºããâ¡ ¼ãÀ¶ãã ÖãñØããý

‚ããõÀ ‡ãŠ½¹ã¶ããè ´ãÀã ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ ã䪆 •ãã ÀÖñ ¹ãÆãäÍãàã¥ã ‡ãŠãñ ½ãªªñ¶ã•ãÀ ÀŒã¦ãñ Öì† •ã½ãã¶ã¦ããè ¾ãÖãâ ¶ããèÞãñ ªãè ØãƒÃ Íã¦ããô ¹ãÀ „¹ã¾ãìÇ㋦㠺ããâ¡
¼ãÀ¶ãñ ‡ãñŠ ãäÊㆠÔãÖ½ã¦ã Öãñ Øã¾ãã Öõ ý

‚ãºã ºããâ¡ ƒÔã ºãã¦ã ‡ãŠã Ôããàããè Öõ:

1. ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠ½¹ã¶ããè ´ãÀã †‡ãŠ ÌãÓãà ‡ãñŠ ãäÊㆠã䪾ãã •ãã¶ãñ ÌããÊãã ¹ãÆãäÍãàã¥ã ÊãñØãã ãä•ãÔãñ ‡ãŠ½¹ã¶ããè ‡ãŠãè ƒÞœã Ôãñ ºãü¤ã¾ãã •ãã
Ôã‡ãŠ¦ãã Öõ ‚ããõÀ ƒÔã ªãõÀã¶ã ÌãÖ ½ãñÖ¶ã¦ã, ÊãØã¶ã ‚ããõÀ ‚ã¹ã¶ããè ¾ããñؾã¦ãã ‡ãñŠ ‚ã¶ãìÔããÀ ¹ãÆãäÍãàã¥ã ÊãñØãã ‚ããõÀ ‡ãŠ½¹ã¶ããè ‡ãñŠ ¹ãÆãä¦ã
ƒÃ½ãã¶ãªãÀãè, ãä¶ã¾ã½ãã¶ãìÔããÀ ‚ããõÀ ‚ãã—ãã‡ãŠãÀãè Öãñ ‡ãŠÀ ‚ããÞãÀ¥ã ‚ããõÀ ̾ãÌãÖãÀ ‡ãŠÀñØãã ¦ã©ãã ‚ã¹ã¶ãã ÔããÀã Ôã½ã¾ã ¶ããõ‡ãŠÀãè ‡ãñŠ
ªããä¾ã¦Ìããò ‡ãŠãñ Ôã½ããä¹ãæ㠇ãŠÀñØãã ¦ã©ãã ¹ãƦ¾ãàã ¾ãã ¹ãÀãñàã ¹ã Ôãñ ‚㶾㠇ãŠãñƒÃ ‡ãŠãÀãñºããÀ, ̾ãã¹ããÀ ¾ãã ̾ãÌãÔãã¾ã ¶ãÖãé ‡ãŠÀñØããý

2. Ôã¹ãŠÊã¦ãã¹ãîÌãÇ㊠¹ãÆãäÍãàã¥ã ¹ãîÀã ‡ãŠÀ¶ãñ ¹ãÀ ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãñ ÔãÖã¾ã‡ãŠ ‚ããä£ã‡ãŠãÀãè, ØãÆñ¡-II ‡ãñŠ ¹㠽ãò Á...............‡ãñŠ
Ìãñ¦ã¶ã½ãã¶ã ½ãò ‡ãŠ½¹ã¶ããè ½ãò Íãããä½ãÊã ‡ãŠÀ ãäÊã¾ãã •ãã†Øãã ‚ããõÀ ÌãÖ ‡ãŠ½¹ã¶ããè ½ãò ¾ãã „Ôã‡ãŠãè ƒÞœã Ôãñ ¼ããÀ¦ã ÔãÀ‡ãŠãÀ ‡ãñŠ ‚㶾ã
ãä‡ãŠÔããè ãäÌã¼ããØã ¾ãã ‚ããõ²ããñãäØã‡ãŠ „¹ã‰ãŠ½ã ½ãò ¦ããè¶ã ÌãÓãà ¦ã‡ãŠ ¶ããõ‡ãŠÀãè ‡ãŠÀñØãã ºãÍã¦ãó ãä‡ãŠ ƒÔã ‚ãÌããä£ã ‡ãñŠ ¹ãîÀã Öãñ¶ãñ Ôãñ ¹ãÖÊãñ Öãè
„Ôã‡ãŠãè ÔãñÌãã†â Ôã½ã㹦㠶㠇ãŠÀ ªãè ØãƒÃ Öãòý

3. ‡ãñŠÌãÊã ŒãÀãºã ÔÌããÔ©¾ã ‡ãñŠ ‡ãŠãÀ¥ã ‡ãŠãñ œãñü¡‡ãŠÀ, •ããñ „Ôã‡ãŠãè ‚ã¹ã¶ããè Êãã¹ãÀÌããÖãè ¾ãã ªìÀãÞãÀ¥ã ‡ãñŠ ‡ãŠãÀ¥ã ¶ãÖãé Öõ ‚ããõÀ
ãä•ãÔã‡ãñŠ ãäÊㆠ‡ãŠ½¹ã¶ããè ´ãÀã ½ã¶ããñ¶ããè¦ã ãäÞããä‡ãŠ¦Ôãã ‚ããä£ã‡ãŠãÀãè ‡ãŠã ¹ãƽãã¥ã¹ã¨ã ãä¶ã¥ããþã‡ãŠ ‚ããõÀ ½ã㶾ã ÖãñØãã, ¹ãÆãäÍãàã¥ãã©ããê
ãä¶ããäªÃÓ› ¾ãã ºãü¤ã¾ããè Øã¾ããè ‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ¹ãÆãäÍãàã¥ã ¾ãã …¹ãÀ ºã¦ãã¾ããè Øã¾ããè ¦ããè¶ã ÌãÓãà ‡ãŠãè ‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ‡ãŠ½¹ã¶ããè ‡ãŠãè
ÔãñÌãã ¶ãÖãé œãñü¡ñØããý

4. ¹ãÆãäÍãàã¥ãã©ããê ÖÀ Ôã½ã¾ã ‚ããõÀ Ôã½ã¾ã-Ôã½ã¾ã ¹ãÀ ¦ã¦¹ãÀ¦ãã Ôãñ ‚ã¹ã¶ãñ ‡ãŠã¾ãà ‡ãŠÀñØãã ‚ããõÀ ‡ãŠ½¹ã¶ããè ‡ãñŠ Ôã¼ããè ãä¶ã¾ã½ããò ‚ããõÀ
ãäÌããä¶ã¾ã½ããò ‡ãŠã ¹ããÊã¶ã ‡ãŠÀñØãã, ÌãÖ ‚ããä£ã‡ãðŠ¦ã ̾ããä‡ã‹¦ã¾ããò ‡ãñŠ ‚ããªñÍããò ‚ããõÀ ãäÖªã¾ã¦ããò ‡ãŠã ¹ããÊã¶ã ‡ãŠÀñØããý

5. ¹ãÆãäÍãàã¥ãã©ããê ‚ã¹ã¶ãñ ¹ãÆãäÍãàã¥ã ‚ããõÀ Àãñ•ãØããÀ ‡ãñŠ ªãõÀã¶ã ¹ã¦ãã ÞãÊã¶ãñ ÌããÊããè „Ôã‡ãñŠ ‡ãŠã¾ãà ¾ãã ØãÆãÖ‡ãŠãò Ôãñ Ôãâºãâãä£ã¦ã ‡ãŠãñƒÃ ¼ããè
Øããñ¹ã¶ããè¾ã ºãã¦ãò, ¦ã‡ãŠ¶ããè‡ãŠãè •ãã¶ã‡ãŠãÀãè ¾ã㠂㶾㠇ãŠãñƒÃ •ãã¶ã‡ãŠãÀãè ãä‡ãŠÔããè ¼ããè ¦ãÀÖ ãä‡ãŠÔããè ̾ããä‡ã‹¦ã ¾ãã ̾ããä‡ã‹¦ã¾ããò ‡ãŠãñ ¶ãÖãé
ºã¦ãã†Øããý

6. ¹ãÆãäÍãàã¥ãã©ããê „‡ã‹¦ã ‡ãŠ½¹ã¶ããè ‡ãŠãè Ôã½¹ããä§ã ¾ãã Þããè•ããò ‡ãŠãñ ºãñ‡ãŠãÀ ¶ãÖãé ‡ãŠÀñØãã, ŒãÀãºã ¶ãÖãé ‡ãŠÀñØãã ‚ããõÀ ¶ã Öãè „¶Öò ¶ãì‡ãŠÔãã¶ã
¹ãÖìâÞãã†Øãã ‚ã©ãÌã㠇㊽¹ã¶ããè ‡ãŠãè ÔãÖ½ããä¦ã ‡ãñŠ ãäºã¶ãã ãä‡ãŠÔããè ̾ããä‡ã‹¦ã ‡ãŠãñ „£ããÀ ¶ãÖãé ªñØããý

•ã½ãã¶ã¦ããè ‡ãñŠ ÖÔ¦ããàãÀ

7. ¹ãÆãäÍãàã¥ãã©ããê ãä‡ãŠÔããè ½ã•ãªîÀ ¾ãã Àã•ã¶ããèãä¦ã‡ãŠ Øããä¦ããäÌããä£ã ½ãò ¼ããØã ¶ãÖãé ÊãñØãã ‚ã©ãÌãã ãä‡ãŠÔããè ½ã•ãªîÀ ¾ãã Àã•ã¶ãõãä¦ã‡ãŠ ÔãâØ㟶ã
‡ãŠã ÔãªÔ¾ã ¶ãÖãé ºã¶ãñØããý

8. ¾ããäª ¹ãÆãäÍãàã¥ãã©ããê ‚ã¹ã¶ãã ¹ãÆãäÍãàã¥ã ¹ãîÀã ¶ãÖãé ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè ‚ã©ãÌã㠇㊽¹ã¶ããè ´ãÀã ã䪆 Øㆠ¹ãÆãäÍãàã¥ã ‡ãŠãñ Ôã¹ãŠÊã¦ãã¹ãîÌãÇãŠ
¹ãîÀã ‡ãŠÀ Êãñ¶ãñ ‡ãñŠ ¦ãìÀ¶¦ã ºã㪠¦ããè¶ã ÌãÓãà ¦ã‡ãŠ ‡ãŠ½¹ã¶ããè ‡ãŠãè ¶ããõ‡ãŠÀãè ¶ãÖãé ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè ¦ããñ „Ôãñ ‚ã¹ã¶ãñ ¹ãÆãäÍãàã¥ã ‡ãñŠ Ôãâºãâ£ã ½ãò
‡ãŠ½¹ã¶ããè ´ãÀã „Ÿã† Øㆠ̾ã¾ã ‡ãŠãñ ƒÔã½ãò ºã¦ãㆠ‚ã¶ãìÔããÀ ½ãì‚ããÌã•ãã ªñ¶ãã ÖãñØããý ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹ãÆãäÍãàã¥ã ‡ãñŠ Ôãâºãâ£ã ½ãò
‡ãŠ½¹ã¶ããè ´ãÀã „Ÿã† Øㆠ̾ã¾ã ½ãò ¹ãÆãäÍãàã¥ã ‚ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ªãè ØãƒÃ ¹ããäÀÊãã亣ã¾ããâ, ¹ã¾ãÃÌãñàã¥ã ‚ããõÀ ‚㶾ã Þããè•ããò ‡ãŠãè
ÊããØã¦ã ‚ãããäª Íãããä½ãÊã Öõý ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹ãÆãäÍãàã¥ã ¹ãÀ ‡ãŠ½¹ã¶ããè ´ãÀã ŒãÞãà ãä‡ãŠ† ‡ãìŠÊã ̾ã¾ã ‡ãŠã ‚ãâãä¦ã½ã ãä¶ã¥ãþ㠇㊽¹ã¶ããè
‡ãñŠ ‡ãŠã¾ãÇãŠãÀãè ãä¶ãªñÍã‡ãŠ/½ãÖã¹ãƺãâ£ã‡ãŠ ¾ãã ƒ¶ã½ãò Ôãñ ãä‡ãŠÔããè †‡ãŠ ´ãÀã ƒ¶ã‡ãñŠ ´ãÀã ½ã¶ããñ¶ããè¦ã ‚ããä£ã‡ãŠãÀãè ‡ãŠãñ ÖãñØããý ãä¹ãŠÀ ¼ããè
ÌãÔãîÊããè •ãã¶ãñ ÌããÊããè ‡ãìŠÊã À‡ãŠ½ã ¹ãÞããÔã Ö•ããÀ Á¹ã† Ôãñ ‚ããä£ã‡ãŠ ¶ãÖãé ÖãñØããèý

9. ‡ãŠ½¹ã¶ããè ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹ãÆãäÍãàã¥ã ‡ãŠãè ¹ãÆØããä¦ã ¾ãã „Ôã‡ãñŠ ÔÌããÔ©¾ã ‡ãñŠ Ôãâºãâ£ã ½ãò ¹ãÆãä¦ã‡ãîŠÊã ãäÀ¹ããñ›Ã Öãñ¶ãñ ¹ãÀ ‚ã¹ã¶ããè ƒÞœã Ôãñ
¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ¹ãÆãä¦ã ‡ãŠãñƒÃ ãä•ã½½ãñªãÀãè ¶ã ÀŒã¦ãñ Öì† „‡ã‹¦ã ¹ãÆãäÍãàã¥ã ½ãò ¹ããäÀÌã¦ãöã, ÖÔ¦ãàãñ¹ã ¾ãã „Ôãñ Ôã½ã㹦㠇ãŠÀ Ôã‡ãŠ¦ããè
Öõý

10. ¾ããäª ¹ãÆãäÍãàã¥ãã©ããê ¹ãÆãäÍãàã¥ã ¹ãîÀã ‡ãŠÀ¶ãñ ‡ãñŠ ºã㪠¦ããè¶ã ÌãÓãà ‡ãŠãè ãä¶ã£ããÃãäÀ¦ã ‚ãÌããä£ã Ôãñ ¹ãÖÊãñ ¶ããõ‡ãŠÀãè œãñü¡¶ãã ÞããÖñ ¦ããñ „Ôãñ
‚ã¹ã¶ãñ ¹ãÆãäÍãàã¥ã ¹ãÀ ‡ãŠ½¹ã¶ããè ´ãÀã ãä‡ãŠ¾ãã Øã¾ãã ̾ã¾ã Êããõ›ã¶ãã ÖãñØããý „Ôãñ ¦ããè¶ã ½ãÖãè¶ãñ ‡ãŠã ¶ããñãä›Ôã ¾ãã „Ôã‡ãñŠ ºãªÊãñ ½ãò ¦ããè¶ã
½ãÖãè¶ãñ ‡ãñŠ Ìãñ¦ã¶ã ‡ãñŠ ºãÀãºãÀ ÀããäÍã ¼ããè Þãì‡ãŠã¶ããè ÖãñØããèý

11. ¹ãÆãäÍãàã¥ãã©ããê ƒÔã ‡ãŠÀãÀ ‡ãñŠ ãä¶ã¾ã½ããò ‚ããõÀ Íã¦ããô ¹ãÀ Ö½ãñÍãã ºã㣾ã ÀÖñØãã ‚ããõÀ ‡ãŠ½¹ã¶ããè ‡ãŠãñ •ã½ãã¶ã¦ããè ¹ãÀ ºããâ¡ ÊããØãî ‡ãŠÀ¶ãñ
‡ãñŠ ãäÊㆠ‡ãŠãÀÃÌããƒÃ ‡ãŠÀ¶ãñ ¾ãã £ã¶ã ÌãÔãîÊã¶ãñ ‡ãŠãè ÔÌã¦ãâ¨ã¦ãã ÖãñØããè ‚ããõÀ ‡ãŠ½¹ã¶ããè ‡ãñŠ ãäÊㆠ¾ãÖ •ãÂÀãè ¶ãÖãé ÖãñØãã ãä‡ãŠ Ìããñ ºããâ¡
‡ãŠãñ ÊããØãî ‡ãŠÀ¶ãñ ‡ãñŠ ãäÊㆠ¹ãÆãäÍãàã¥ãã©ããê ‡ãñŠ ãäÌã® ‡ãŠãÀÃÌããƒÃ ‡ãŠÀñý

12. •ã½ãã¶ã¦ããè ´ãÀã ãäÊㆠØㆠªããä¾ã¦Ìããò ¹ãÀ ‡ãŠ½¹ã¶ããè ´ãÀã ¹ãÆãäÍãàã¥ãã©ããê ¹ãÀ ã䪌ããƒÃ ØãƒÃ ‡ãðŠ¹ãã ¾ãã Ôã½ã¾ã-ãäÌãÔ¦ããÀ Ôãñ ‡ãŠãñƒÃ ‚ãâ¦ãÀ
¶ãÖãé ¹ãü¡ñØããý

ãä•ã¶ã‡ãŠãè Ôããàããè ½ãò •ã½ãã¶ã¦ããè ¶ãñ „¹ã¾ãìÇ㋦㠦ããÀãèŒã ‡ãŠãñ ƒÔã ºããâ¡ ¹ãÀ ÖÔ¦ããàãÀ ãä‡ãŠ†

Ôãããäàã¾ããò ‡ãŠãè „¹ããäÔ©ããä¦ã ½ãò:

1. ÖÔ¦ããàãÀ................................. ÖÔ¦ããàãÀ ......................

(•ã½ãã¶ã¦ããè)

¶ãã½ã.................................... ¶ãã½ã ..........................

̾ãÌãÔãã¾ã............................... ̾ãÌãÔãã¾ã......................
¹ã¦ãã................................... ¹ã¦ãã..........................

2. ÖÔ¦ããàãÀ................................. •ã½ãã¶ã¦ããè ‡ãñŠ ÖÔ¦ããàãÀ ãä¶ã½¶ããäÊããäŒã¦ã ‡ãñŠ ´ãÀã Ô㦾ãããä¹ã¦ã

(•ã½ãã¶ã¦ããè)

¶ãã½ã....................................
̾ãÌãÔãã¾ã............................... ÖÔ¦ããàãÀ......................
¹ã¦ãã................................... ¶ãã½ã..........................
(½ããñÖÀ ÔããäÖ¦ã)
 ¹ããäÀãäÍãÓ›-V

ÔÌããè‡ãðŠãä¦ã-¹ã¨ã

ÔãñÌãã ½ãò,

_________________________________
_________________________________
________________________________
__________________________________

½ãÖãñª¾ã,

ãäÌãÓã¾ã: ¹ã¾ãÃÌãñàã‡ãŠ ¹ãÆãäÍãàã¥ãã©ããê ‡ãŠãè ãä¶ã¾ãìãä‡ã‹¦ã

ºããè†ÞãƒÃ†Êã ½ãò ¹ã¾ãÃÌãñàã‡ãŠ ¹ãÆãäÍãàãã©ããê ‡ãñŠ ãä¶ã¾ãìãä‡ã‹¦ã ¹ãÆÔ¦ããÌã ‡ãñŠ Ôã⪼ãà ½ãò ‚ãã¹ã‡ãŠãñ ÔãîãäÞã¦ã ‡ãŠÀ¦ãã Öîâ ãä‡ãŠ ½ãö¶ãñ ƒÔã ãä¶ã¾ãìãä‡ã‹¦ã ¹ãÀ ÊããØãî Öãñ¶ãñ
ÌããÊãñ ãä¶ã¾ã½ããò ‚ããõÀ Íã¦ããô ‡ãŠãñ ¹ãü¤ ãäÊã¾ãã Öõ ‚ããõÀ „¶Öò ÔÌããè‡ãŠãÀ ‡ãŠÀ¦ãã Öîâý

½ãö •ãã¶ã¦ãã Öîâ ãä‡ãŠ ½ãì¢ãñ .....................................‡ãŠãñ ½ãñÀã ¦ãõ¶ãã¦ããè ‡ãŠãè ãä¡Ìããè•ã¶ã ‡ãñŠ ½ãã¶ãÌã ÔãâÔãã£ã¶ã ãäÌã¼ããØã ‡ãñŠ ¹ãƽãìŒã ‡ãŠãñ
¹ãÆãäÍãàã¥ã ‡ãñŠ ãäÊㆠãäÀ¹ããñ›Ã ‡ãŠÀ¶ããè Öõý ½ãö..............................‡ãŠãñ ãäÀ¹ããñ›Ã ‡ãŠÂâØããý

¼ãÌãªãè¾ã

............................
(ÖÔ¦ããàãÀ)

¦ããÀãèŒã: ¶ãã½ã .............................................

(Ô¹ãÓ› ‚ãàãÀãò ½ãò)

Ô©ãã¶ã: ÀãñÊã ¶ãâ.........................................

 AA: ETX: ETP 8: R0: 12/09

¼ããÀ¦ã ÖñÌããè ƒÊãñãä‡ã‹›È‡ãŠÊÔã ãäÊããä½ã›ñ¡

BHARAT HEAVY ELECTRICALS LIMITED
____________________________ ¹ããäÀãäÍãÓ› - VII
ANNEXURE - VII

Ôããà¾ãâ‡ãŠ¶ã ¹ã¨
ATTESTATION FORM

I. Þãñ¦ããÌã¶ããè Ôããà¾ãâ‡ãŠ¶ã ¹ã¨ã ½ãò ¢ãîŸãè •ãã¶ã‡ãŠãÀãè ªñ¶ãã ¾ãã ãä‡ãŠÔããè ¦ã©¾ã ‡ãŠãñ ã䜹ãã¶ãã ‚ã¾ããñؾã¦ãã ÖãñØããè ‚ããõÀ „½½ããèªÌããÀ ‡ãŠãñ ÔãÀ‡ãŠãÀãè ¶ããõ‡ãŠÀãè
¹ãã¶ãñ ‡ãñŠ ãäÊㆠ‚ã¾ããñؾã ÜããñãäÓã¦ã ãä‡ãŠ¾ãã •ãã Ôã‡ãŠ¦ãã Öõ ý
Affix passport size (5X7)
WARNING The furnishing of false information or suppression of any factual information in the Attestation form would photograph duly attested
be a disqualification, and is likely to render the candidate unfit for employment under the Government. by a gazetted officer

II. ¾ããäª ƒÔã ¹ãŠã½ãà ‡ãŠãñ ¼ãÀ‡ãŠÀ ªããäŒãÊã ‡ãŠÀ¶ãñ ‡ãñŠ ºã㪠„½½ããèªÌããÀ À•ãÀºãâª, ãäØãÀ¹ã‹¦ããÀ ãä‡ãŠ¾ãã Øã¾ãã Öãñ, ½ãì‡ãŠª½ãã ÞãÊãã Öãñ, ½ãìÞãÊã‡ãñŠ, •ãì½ããöãã ¾ãã
Ôã•ãã ÖìƒÃ Öãñ ¦ããñ ÌãÖ ƒÔã Ôãâºãâ£ã ½ãò º¾ããõÀñ ¦ã¦‡ãŠãÊã „Ôã ‚ããä£ã‡ãŠãÀãè ‡ãŠãñ ¼ãñ•ãñØãã ãä•ãÔãñ ¹ãÖÊãñ Ôããà¾ãâ‡ãŠ¶ã ¹ã¨ã ¼ãñ•ãã Øã¾ãã Öõ, †ñÔã㠶㠇ãŠÀ¶ã㠦㩾ããò
‡ãŠãñ ã䜹ãã¶ãã Ôã½ã¢ãã •ãã†Øãã / If detained, arrested, prosecuted, bound down, fined, convicted, debarred, acquitted etc.
subsequent to the completion and submission of this form, the detils should be communicated immediately to the authorities to whom the attestation
form has been sent early, failing which it will be deemed to be a suppression of factual information.

III. ¾ããäª ãä‡ãŠÔããè ̾ããä‡ã‹¦ã ‡ãñŠ ÔãñÌãã‡ãŠãÊã ‡ãñŠ ªãõÀã¶ã ãä‡ãŠÔããè ¼ããè Ôã½ã¾ã ƒÔ㠦㩾㠇ãŠãè •ãã¶ã‡ãŠãÀãè ãä½ãÊã¦ããè Öõ ãä ‡ãŠ Ôããà¾ãâ‡ãŠ¶ã-¹ã¨ã ½ãò ¢ãîŸãè •ãã¶ã‡ãŠãÀãè ªãè ØãƒÃ Öõ ¾ãã ãä‡ãŠÔããè ¼ããè ¦ã©¾ã¹ãî¥ãÃ
•ãã¶ã‡ãŠãÀãè ‡ãŠãñ ã䜹ãã¾ãã Øã¾ãã Öõ ¦ããñ †ñÔãñ ̾ããä‡ã‹¦ã ‡ãŠãè ÔãñÌãã Ôã½ã㹦㠇ãŠãè •ãã Ôã‡ãñŠØããè / If the fact that false information has been furnished or that there has benn
suppression of any factual information in the attestation form; comes to notice at any time during the service of a person his services would be liable
to the terminated.

IV. ¹ãƦ¾ãñ‡ãŠ ¹ãÆͶ㠇ãñŠ ãäÊㆠ"Öãâ" ¾ãã "¶ãÖãé" ¹ãÀ ãä¶ãÍãã¶ã ÊãØãã‡ãŠÀ •ãõÔãã ÊããØãî Öãñ, „¦¦ãÀ ã䪾ãñ •ãã¶ãñ ÞãããäÖ† / Specific answer to each of the question should be given by
striking 'Yes or No' as the case may be.
1. ¹ãîÀã ¶ãã½ã „¹ã¶ãã½ã ÔããäÖ¦ã, ¾ããäª Öãñ ¦ããñ / ‡ãìŠÊã ¶ãã½ã ¶ãã½ã
Name in full (in block capitals) with aliases, if any SURNAME NAME

( ‡ãðŠ¹ã¾ãã ºã¦ãã†â ¾ããäª ‚ã¹ã¶ãñ ¶ãã½ã ¾ãã ‡ãìŠÊã ¶ãã½ã ‡ãñŠ ãä‡ãŠÔããè ¼ããè ¼ããØã ½ãò ãä‡ãŠÔããè ¼ããè Ôã½ã¾ã ‡ã슜 •ããñü¡ã ¾ãã œãñü¡ã Öãñý / Please indicate if you have added or dropped in any
stage any part of your name or surname)

2. ¹ãîÀã Ìã¦ãýãã¶ã ¹ã¦ãã (‚ã©ããæã ØãÆã½ã, ©ãã¶ãñ ‚ããõÀ ãä•ãÊãñ ‡ãŠã ¶ãã½ã ¾ãã ½ã‡ãŠã¶ã ¶ã½ºãÀ/ØãÊããè/Ôãü¡‡ãŠ/Àãñü¡ ‚ããõÀ ¶ãØãÀ) / Present address in full (i.e. Village, Thana, and District
or House No. Lane/Strret/Road and Town)

3. (‡ãŠ/a) ÜãÀ ‡ãŠã ¹ãîÀã ¹ã¦ãã (‚ã©ããæã ØãÆã½ã, ©ãã¶ãñ ‚ããõÀ ãä•ãÊãñ ‡ãŠã ¶ãã½ã ¾ãã ½ã‡ãŠã¶ã ¶ã½ºãÀ/ØãÊããè/Ôãü¡‡ãŠ/Àãñü¡ ¦ã©ãã ¶ãØãÀ ¦ã©ãã ãä•ãÊãã ½ã쌾ããÊã¾ã ‡ãŠã ¶ãã½ã ) Home Address in full
(i.e. Village, Thana, and District or House No. Lane/Strret/Road and Town and name of District Headquarters.)
 (Œã/b) ¾ããäª ½ãîÊã¦ã: ¹ãããä‡ãŠÔ¦ãã¶ã ‡ãñŠ ãä¶ãÌããÔããè Öãñ ¦ããñ „Ôã ªñÍã ‡ãŠã ¹ã¦ãã ‚ããõÀ ¼ããÀ¦ã ÔãâÜã ½ãò ¹ãÆÌããÔã ‡ãŠãè ¦ããÀãèŒã /If originally a resident of Pakistan the address in that
country and the date of migration to Indian Union.

4. ãä¹ãœÊãñ ¹ããâÞã ÌãÓããô ‡ãñŠ ªãõÀã¶ã, †ñÔãñ Ô©ãã¶ããò ‡ãñŠ º¾ããõÀñ (ãä¶ãÌããÔã ‡ãŠãè ‚ãÌããä£ã ÔããäÖ¦ã) ªãèãä•ã†, •ãÖãâ ‚ãã¹ã †‡ãŠ ºããÀ ½ãò †‡ãŠ ÌãÓãà Ôãñ ‚ããä£ã‡ãŠ Ôã½ã¾ã ¦ã‡ãŠ ÀÖ Þãì‡ãñŠ Öãò ý ãäÌãªñÍã (¹ãããä‡ãŠÔ¦ãã¶ã)
½ãò ãä¶ãÌããÔã ‡ãŠÀ¶ãñ ‡ãŠãè ªÍãã ½ãò, †ñÔãñ Ô©ãã¶ããò ‡ãñŠ º¾ããõÀñ ã䪾ãñ •ãã¶ãñ ÞãããäÖ† •ãÖãâ ‚ãã¹ã 21 ÌãÓãà ‡ãŠãè ‚ãã¾ãì ¹ãÆ㹦㠇ãŠÀ¶ãñ ‡ãñŠ ºã㪠†‡ãŠ ÌãÓãà Ôãñ ‚ããä£ã‡ãŠ Ôã½ã¾ã ¦ã‡ãŠ ÀÖñ Öãò / Particulars of
places (with periods of residence), where you have resided for more than one year at a time during the preceding five years. In case of stay abroad
(including Pakistan) of all places where you have resided for more than one year attaining the age of 21 years, should be given.

Ôãñ/From ¦ã‡ãŠ/to ãä¶ãÌããÔã ‡ãŠã ¹ãîÀã ¹ã¦ãã (‚ã©ããæã ØãÆã½ã, ãä¹ãœÊãñ ‡ãŠãÊã½ã ½ãò Ìããä¥ãæã
©ãã¶ãñ ‚ããõÀ ãä•ãÊãñ ‡ãŠã ¶ãã½ã ¾ãã ½ã‡ãŠã¶ã Ô©ãã¶ã ‡ãñŠ ãä•ãÊãã ½ã쌾ããÊã¾ã
¶ã½ºãÀ/ØãÊããè/Ôãü¡‡ãŠ ‚ããõÀ ¶ãØãÀ) ‡ãŠã ¶ãã½ã /
Residential address in full (i.e. Village, Name of the District Headquarters of
Thana and District or and Town) the place mentioned in the preceding col.

SNo From To Residential Address District Headquarters

5.
Occupation (if
Nationality (by employed give
Present postal Permanent
SNo Relation Name birth/or by Place of birth designation &
address home address
domicile) official
address)
1 Father

2 Mother

3 Spouse

4 Brother (s)

8 Sister(s)

10
6.(‡ãŠ/a) ‚ã¹ã¶ãñ †ñÔãñ ¹ãì¨ã (¹ãì¨ããò) ‚ããõÀ/¾ãã Êãü¡‡ãŠãè (Êãü¡ãä‡ãŠ¾ããò) ‡ãñŠ Ôãâºãâ£ã ½ãò •ãã¶ã‡ãŠãÀãè ªãèãä•ã† •ããñ ãäÌãªñÍã ½ãò ¹ãü¤ ÀÖñ Öãò/ÀÖ ÀÖñ Öãòý / Information to be furnished with regard
to son(s) and/or daughter(s) in case they are studying in a foreign country.

¶ãã½ã Name ____________________________________________________

ÀãÓ›Èãè¾ã¦ãã(•ã¶½ã Ôãñ ‚ããõÀ/¾ãã ¹ãÆÌããÔããè Öãñ¶ãñ Ôãñ)/ Nationality (by birth and/or by domicile) ______________________________________________

•ã¶½ã Ô©ãã¶ã / Place of birth ______________________________________________

„Ôã ªñÍã ‡ãŠã ¶ãã½ã ¹ãîÀñ ¹ã¦ãñ ÔããäÖ¦ã/•ãÖãâ ¹ãü¤ ÀÖñ/ÀÖ ÀÖñ Öãò / Country in which studying/living with full address ________________________________________

¹ãÖÊãñ ‡ãŠãÊã½ã ½ãò Ìããä¥ãæ㠪ñÍã ½ãò ãä‡ãŠÔã ¦ããÀãèŒã Ôãñ ¹ãü¤ ÀÖñ/ÀÖ ÀÖñ Öãò / Date from which studying living in the country mentioned in previous column.____________

7. Date of birth _______________________________________________________

Ìã¦ãýãã¶ã ‚ãã¾ãì /Present age _______________________________________________________

½ãõãä›È‡ãŠ ¹ããÔã ‡ãŠÀ¶ãñ ‡ãñŠ Ôã½ã¾ã ‚ãã¾ãì / Age at Matriculation ______________________________________________

8. •ã¶½ã Ô©ãã¶ã, ãä•ãÊãã ‚ããõÀ À㕾㠇ãŠã ¶ãã½ã •ãÖãâ ãäÔ©ã¦ã Öãò / Place of birth, District and State in which situated _______________________________________

ãä•ãÊãã ‚ããõÀ À㕾㠕ãÖãâ ‡ãñŠ ‚ãã¹ã ÀÖÊãñ ÌããÊãñ Öö / District and State to which you belong __________________________________________________________

ÌãÖ ãä•ãÊãã ‚ããõÀ À㕾㠕ãÖãâ ‡ãñŠ ‚ãã¹ã‡ãñŠ ãä¹ã¦ãã ½ãîÊã¦ã: ÀÖÊãñ ÌããÊãñ Öö / District and State to which your father originally belongs ______________________________

9. ‚ãã¹ã ‡ãŠã £ã½ãà / Your religion ______________________________

‡ã‹¾ãã ‚ãã¹ã ‚ã¶ãìÔãìãäÞã¦ã •ãããä¦ã/•ã¶ã•ãããä¦ã ‡ãñŠ Öö ? „¦¦ãÀ "Öãâ" ¾ãã "¶ãÖãé" ½ãò ªãèãä•ã† / Are you a member od Scheduled Caste/Scheduled Tribe? Answer 'Yes' or 'No'
10. 15 ÌãÓãà ‡ãŠãè ‚ãã¾ãì ‡ãñŠ ¹ãÍÞãã¦ãá „¶ã Íãõàããä¥ã‡ãŠ Ô©ãã¶ããò ‡ãñŠ ¶ãã½ã, ÌãÓãà ÔããäÖ¦ã ãäÊãŒãò ãä•ã¶ã Ô‡ãîŠÊããò ‚ããõÀ ‡ãŠãÊãñ•ããò Ôãñ Íãõãäàããä¥ã‡ãŠ ¾ããñؾã¦ãã†â ¹ãÆ㹦㠇ãŠãè Öö / Educational
Qualifications showing places of education with years in Schools and Colleges since 15th year of age.
¹ãîÀñ ¹ã¦ãñ ÔããäÖ¦ã Ô‡ãîŠÊã / ‡ãŠãÊãñ•ã ‡ãŠã ¶ãã½ã ¹ãÆÌãñÍã ‡ãŠãè ¦ããÀãèŒã œãñü¡¶ãñ ‡ãŠãè ¦ããÀãèŒã „¦¦ããè¥ãà ¹ãÀãèàãã
Name of School/ Date of Date of Examinations
College with full address entering leaving passed

Name of School/ Date of Date of

Examinations passed
College with full address entering leaving

11. (‡ãŠ/a) ‡ã‹¾ãã ‚ãã¹ã ‡ãñŠ¶³ãè¾ã ¾ãã À㕾ã ÔãÀ‡ãŠãÀ ¾ãã ãä‡ãŠÔããè ‚ã£ãÃ-ÔãÀ‡ãŠãÀãè ¾ãã ÔãÀ‡ãŠãÀãèÌã¦ãá ãä¶ã‡ãŠã¾ã ¾ãã ÔÌãã¾ã¦ã ãä¶ã‡ãŠã¾ã ¾ãã ÔãÀ‡ãŠãÀãè „¹ã‰ãŠ½ã ¾ãã ãä¶ã•ããè ¹ãŠ½ãà ¾ãã ¹ãÆãä¦ãÓŸã¶ã ½ãò ¶ããõ‡ãŠÀãè
‡ãŠÀ ÀÖñ Öö ¾ãã ãä‡ãŠÔããè ¼ããè Ôã½ã¾ã ‡ãŠÀ Þãì‡ãñŠ Öö ? ¾ããäª †ñÔãã Öõ ¦ããñ ‚ã¼ããè ¦ã‡ãŠ ‡ãŠãè ¶ããõ‡ãŠÀãè ‡ãñŠ ¹ãîÀñ º¾ããõÀñ ¦ããÀãèŒããò Ôããä֦㠪ãèãä•ã† / Are you holding or have any time held an
appointment under the Central or State Government or a semi-Government or a Quasi-Government body, or an autonomous body, or a public
undertaking, or a private firm or institution? If so,give full particulars with date of employment up-to-date.

‚ãÌããä£ã ¹ãª, Ìãñ¦ã¶ã ‚ããõÀ ãä¶ã¾ããñ‡ã‹¦ãã ‡ãŠã ¹ãîÀã ¶ãã½ã ‚ããõÀ ¹ã¦ãã ãä¹ãœÊããè ¶ããõ‡ãŠÀãè œãñü¡¶ãñ ‡ãŠã ‡ãŠãÀ¥ã
Period ãä¶ã¾ããñ•ã¶ã ‡ãŠã ÔÌãÁ¹ã Full Name & address of employer Reasons for leaving previous service
Ôãñ ¦ã‡ãŠ Designation, employment
and nature of employment
From To
 Designation, employment Full Name & address of Reasons for leaving
From To
and nature of employment employe previous service

11. (Œã/b) ‡ã‹¾ãã ãä¹ãœÊããè ¶ããõ‡ãŠÀãè ¼ããÀ¦ã ÔãÀ‡ãŠãÀ/À㕾ã ÔãÀ‡ãŠãÀ/¼ããÀ¦ã ÔãÀ‡ãŠãÀ ¾ãã À㕾ã ÔãÀ‡ãŠãÀ ‡ãñŠ ÔÌãããä½ã¦Ìã ¾ãã ãä¶ã¾ãâ¨ã¥ã ½ãò ÔãâÞãããäÊã¦ã „¹ã‰ãŠ½ã ÔÌãã¾ã¦ã
ãä¶ã‡ãŠã¾ã/ãäÌãÍÌããäÌã²ããÊã¾ã/Ô©ãã¶ããè¾ã ãä¶ã‡ãŠã¾ã ‡ãñŠ ‚ã£ããè¶ã ©ããè? ‡ã‹¾ãã ‚ãã¹ã¶ãñ ‡ãñŠ¶³ãè¾ã ãäÔããäÌãÊã ÔãñÌãã (‚ãÔ©ãã¾ããè ÔãñÌãã) ãä¶ã¾ã½ã, 1965 ‡ãñŠ ãä¶ã¾ã½ã 5 ¾ãã ãä‡ãŠ¶Öãé Ôã½ãã¶ã ÔãâØã¦ã ãä¶ã¾ã½ããò ‡ãñŠ ‚ã£ããè¶ã
†‡ãŠ ½ããÖ ‡ãŠãè ÔãîÞã¶ãã ªñ‡ãŠÀ ¶ããõ‡ãŠÀãè œãñü¡ãè ©ããè? ‡ã‹¾ãã ‚ãã¹ã‡ãŠãè ÔãñÌãã†â ¾ã©ããÜã¦ã Ôã½ã㹦ã ãä‡ãŠ¾ãñ •ãã¶ãñ ‡ãñŠ ¹ãîÌãÃ, ‚ãã¹ã‡ãñŠ ãäÌãÁ® ‡ãŠãñƒÃ ‚ã¶ãìÍããÔããä¶ã‡ãŠ ‡ãŠã¾ãÃÌããÖãè ‡ãŠãè ØãƒÃ ©ããè ¾ãã ‚ãã¹ã‡ãŠãè ÔãñÌãã†â
Ôã½ã㹦㠇ãŠÀ¶ãñ Ôãâºãâ£ããè ¶ããñãä›Ôã ªñ¶ãñ ¹ãÀ ¾ãã „Ôã‡ãñŠ ºã㪠‡ãŠãè ¦ããÀãèŒã ‡ãŠãñ ãä‡ãŠÔããè ¼ããè ãäÌãÓã¾ã ½ãò ‚ãã¹ã‡ãŠãñ ‚ã¹ã¶ãã ‚ããÞãÀ¥ã Ô¹ãÓ› ‡ãŠÀ¶ãñ ‡ãñŠ ãäÊㆠ‚ããªñÍã ã䪾ãã Øã¾ãã ©ãã? ¾ããäª Öãâ ¦ããñ ‡ãðŠ¹ã¾ãã
ãäÌãÌãÀ¥ã ªò / If the previous employment was under the Govt. of India/State Govt./ an undertaking owned or controlled by the Govt. of India or State
Govt./ an autonoms body/University/Local body. If you had left service on giving a month's notice under rule 5 of the Central Civil Services
(Temporary Services) Rules 1965, or any similar corresponding rules? Were any disciplinary proceedings framed against you, or had you been called
upon to explain your conduct in any matter at the time you have notice or termination of service, or at a subsequent date, before your services
actually terminated? If yes, please furnish details.
12.
(‡ãŠ) ‡ã‹¾ãã ‚ãã¹ã ãäØãÀ¹ã‹¦ããÀ ãä‡ãŠ¾ãñ Øã¾ãñ? Öãâ/¶ãÖãé
(a) Have you ever been arrested? Yes/No

(Œã) ‡ã‹¾ãã ‚ãã¹ã ¹ãÀ ‡ãŠ¼ããè ‚ããä¼ã¾ããñØã ÊãØãã¾ãã Øã¾ãã? Öãâ/¶ãÖãé

(b) Have you ever been prosecuted? Yes/No

(Øã) ‡ã‹¾ãã ‚ãã¹ã‡ãŠãñ ‡ãŠ¼ããè ¶ã•ãÀºã¶ª ãä‡ãŠ¾ãã Øã¾ãã? Öãâ/¶ãÖãé

(c) Have you ever been kept under detention? Yes/No

(Üã) ‡ã‹¾ãã ‚ãã¹ã‡ãŠãñ ‡ãŠ¼ããè ½ãìÞãÊã‡ãñŠ ãä‡ãŠ¾ãñ Øã¾ãñ? Öãâ/¶ãÖãé

(d) Have you ever been bound down? Yes/No

(¡.) ‡ã‹¾ãã ‚ãã¹ã ¹ãÀ ‡ãŠ¼ããè ãä‡ãŠÔããè ¶¾ãã¾ããÊã¾ã ´ãÀã •ãì½ããöãã ãä‡ãŠ¾ãã Øã¾ãã? Öãâ/¶ãÖãé
(e) Have you ever been fined by a Court of Law? Yes/No

(Þã) ‡ã‹¾ãã ‚ãã¹ã ‡ãŠ¼ããè ¼ããè ãä‡ãŠÔããè ‚ã¹ãÀã£ã ‡ãñŠ ãäÊã¾ãñ ¶¾ãã¾ããÊã¾ã ´ãÀã ªâã䡦ã ãä‡ãŠ¾ãñ Øã¾ãñ? Öãâ/¶ãÖãé
(f) Have you ever been convicted by a Court of Law for any offence? Yes/No

(œ) ‡ã‹¾ãã ‚ãã¹ã ‡ãŠ¼ããè ãä‡ãŠÔããè ¹ãÀãèàãã Ôãñ Ìããä•ãæã ãä‡ãŠ¾ãñ Øã¾ãñ ¾ãã ãä‡ãŠÔããè ãäÌãÍÌããäÌã²ããÊã¾ã ¾ãã ãä‡ãŠÔããè ‚ã¶¾ã Íãõàããä¥ã‡ãŠ ¹ãÆããä£ã‡ãŠãÀãè/ÔãâÔ©ãã ´ãÀã ãä¶ãÓ‡ãŠããäÔã¦ã ãä‡ãŠ¾ãñ Øã¾ãñ? Öãâ/¶ãÖãé
(g) Have you ever been debarred from any nomination or rusticated by any University or any other educational authority/institution? Yes/No

(•ã) ‡ã‹¾ãã ‚ãã¹ã ‡ãŠ¼ããè Êããñ‡ãŠ ÔãñÌãã ‚ãã¾ããñØã ´ãÀã „Ôã‡ãŠãè ãä‡ãŠÔããè ¼ããè ¹ãÀãèàãã/Þã¾ã¶ã ‡ãñŠ ãäÊã¾ãñ Ìããä•ãæã/‚ã¾ããñ ؾ㠟ÖÀã¾ãñ Øã¾ãñ? Öãâ/¶ãÖãé
(h) Have you ever been debarred/disqulaified by any Public service Commission/Staff Selection Commission for any of its examination/selection?
YEs/No

(¢ã) ‡ã‹¾ãã ‚ãã¹ã Ôããà¾ãâ‡ãŠ¶ã ¹ã¨ã ¼ãÀ¶ãñ ‡ãñŠ Ôã½ã¾ã ‚ãã¹ã‡ãñŠ ãäÌãÁ® ‡ãŠãñƒÃ ½ãã½ãÊãã, ãä‡ãŠÔããè ¶¾ãã¾ããÊã¾ã ½ãò ÞãÊã ÀÖã Öõ? Öãâ/¶ãÖãé
(i) Is any case pending againseyou in any Court of law at the time of filling up this Attestation Form? Yes/No

(ii) ¾ããäª …¹ãÀ Ìããä¥ãæã ãä‡ãŠ¶Öãé ¼ããè ¹ãÆͶããò ‡ãŠã „¦¦ãÀ 'Öãâ' ½ãò Öãñ ¦ããñ ½ãã½ãÊãã, ãäØãÀ¹ã‹¦ããÀãè/¶ã•ãÀºãâªãè/ •ãì½ããöãã/‚ããä¼ã¾ããñ•ã¶ã/Ôã•ãã/ªâ¡ ‚ãããäª ‡ãñŠ Ôãâºãâ£ã ½ãò ‚ããõÀ ¾ãã ƒÔã ¹ãŠã½ãà ‡ãñŠ ¼ãÀ¶ãñ ‡ãñŠ
Ôã½ã¾ã ãä‡ãŠÔããè ¶¾ãã¾ããÊã¾ã/ãäÌãÍÌããäÌã²ããÊã¾ã/Íãõàããä¥ã‡ãŠ ‚ããä£ã‡ãŠãÀãè ‚ãããäª ‡ãñŠ Ôã½ãàã ÞãÊã ÀÖñ ½ãã½ãÊãñ ‡ãñŠ Ôãâºãâ£ã ½ãò ¹ãîÀñ º¾ããõÀñ ªãèãä•ã¾ãñ / If the answer to any of the above mentioned
questions is Yes, give full particulars of the case/arrest/detention/fine conviction/sentence/punishment etc. and/or the nature of the case pending in the
Court/University/Educational Authority etc, at the time of filling up this form.

13. ‚ã¹ã¶ãñ Ô©ãã¶ããè¾ã †ñÔãñ ªãñ ãä•ã½½ãñªãÀ ¾ãã †ñÔãñ ªãñ ̾ããä‡ã‹¦ã¾ããò ‡ãñŠ ¶ãã½ã †Ìãâ ¹ã¦ãñ ªãèãä•ã† ãä•ã¶Öò ‚ãã¹ã •ãã¶ã¦ãñ Ööý/ Name and address of two responsible persons of your
locality or two reference to whom you are known:

Reference - 1 Reference - 2

½ãö ¹ãƽãããä¥ã¦ã ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè Öîú ãä‡ãŠ ½ãñÀñ ÔãÌããó¦¦ã½ã —ãã¶ã †Ìãâ ãäÌãÍÌããÔã ‡ãñŠ ‚ã¶ãìÔããÀ …¹ãÀ ªãè ØãƒÃ •ãã¶ã‡ãŠãÀãè ÔãÖãè Öõ ‚ããõÀ ¹ãî¥ãà Öõ ½ãì¢ãñ †ñÔããè ãä‡ãŠÔããè ¼ããè ºãã¦ã ‡ãŠãè •ãã¶ã‡ãŠãÀãè ¶ãÖãé Öõ •ããñ
ÔãÀ‡ãŠãÀãè ¶ããõ‡ãŠÀãè ‡ãñŠ ãäÊㆠ½ãñÀãè „¹ã¾ãì‡ã‹¦ãã ½ãò ºãã£ã‡ãŠ Öãñ / I certify that the foregoing information is correct and complete to the best of my knowledge and beleif. I
am not aware of any circumstances which might impair my fitness for employment under Government.

„½½ããèªÌããÀ ‡ãñŠ ÖÔ¦ããàãÀ / Signature of Candidate ..................................

ã䪶ããâ‡ãŠ / Date .....................................................................

Ô©ãã¶ã / Place .....................................................................

 ¹ãÖÞãã¶ã ¹ãƽãã¥ã - ¹ã¨ã / IDENTITY CERTIFICATES

(¹ãƽãã¥ã¹ã¨ã ãä¶ã½¶ããäÊããäŒã¦ã ½ãò Ôãñ ãä‡ãŠÔããè †‡ãŠ ‡ãñŠ ´ãÀã ÖÔ¦ããàããäÀ¦ã Öãñ¶ãã ÞãããäÖ† / Certificate to be signed by any one of the following)

 ‡ãñŠ¶³ãè¾ã ¾ãã À㕾ã ÔãÀ‡ãŠãÀ ‡ãñŠ Àã•ã¹ããä¨ã¦ã ‚ããä£ã‡ãŠãÀãè / Gazetted officers of Central or State Government;
 ÔãâÔ㪠¾ãã À㕾ã ãäÌã£ãã¶ã Ôã¼ãã ‡ãñŠ †ñÔãñ ãä¶ãÌããÃÞã¶ã àãñ¨ã ‡ãñŠ ÔãªÔ¾ã •ãÖãâ ‡ãŠã ÔÌã¾ãâ „½½ããèªÌããÀ ¾ãã „Ôã‡ãñŠ ½ãã¦ãã ãä¹ã¦ãã/ÔãâÀàã‡ãŠ Ôãã½ã㶾ã ãä¶ãÌããÔããè Öãò / Members of
Parliament or State Legislature belonging to the Constituency where the candidate of his parent/guardian is ordinarily resident;
 Ôãºã-ãä¡Ìããè•ã¶ãÊã ½ããä•ãÔ›Èñ›/‚ããä£ã‡ãŠãÀãè / Sub-Divisional Magistrates/Officers;
 ¦ãÖÔããèÊãªãÀ ¾ãã ¶ãã¾ãºã/ã䡹›ãè ¦ãÖÔããèÊãªãÀ •ããñ ½ããä•ãÔ›Èñ›ãè ‚ããä£ã‡ãŠãÀãò ‡ãñŠ ¹ãƾããñØã ‡ãŠÀ¶ãñ ‡ãñŠ ãäÊㆠ¹ãÆããä£ã‡ãðŠ ¦ã Öãò / Tehsildars or Naib/Deputy authorised to exercise
magisterial power;
 ½ã㶾ã¦ãã ¹ãÆ㹦ã Ô‡ãîŠÊã/‡ãŠãÊãñ•ã/ÔãâÔ©ãã¶ã ‡ãñŠ ãä¹ãÆâÔããè¹ãÊã/¹ãÆ£ãã¶ã㣾ãã¹ã‡ãŠ •ãÖãâ „½½ããèªÌããÀ ¶ãñ ‚ãã䶦ã½ã ¹ãü¤ãƒÃ ‡ãŠãè Öãñ /Principal/HEad/Master of the recognised
School/College/Institution where the candidates studied last;
 Œãâ¡ ãäÌã‡ãŠãÔã ‚ããä£ã‡ãŠãÀãè / Block Development Officer;
 ¹ããñÔ› ½ããÔ›À / Post-Masters;
 ¹ãâÞãã¾ã¦ã ãä¶ãÀãèàã‡ãŠ / Panchayat Inspectors.
¹ãƽãããä¥ã¦ã ãä‡ãŠ¾ãã •ãã¦ãã Öõ ãä‡ãŠ ½ãö Ñããè/Ñããè½ã¦ããè/‡ã슽ããÀãè .................................... ¹ãì¨ã/¹ã¦¶ããè/¹ãì¨ããè ............ ...........‡ãŠãñ Øã¦ã .......................ÌãÓãÃ
........................½ããÖ ....................... Ôãñ •ãã¶ã¦ãã/•ãã¶ã¦ããè Öîú ‚ããõÀ ¾ãÖ ãä‡ãŠ ƒ¶ã‡ãñŠ ´ãÀã ã䪾ãñ Øㆠº¾ããõÀñ ½ãñÀñ ÔãÌããó¦¦ã½ã —ãã¶ã †Ìãâ ãäÌãÍÌããÔã ‡ãñŠ ‚ã¶ãìÔããÀ ÔãÖãè Öö /
Certified that I, have know Shri/Smt/Km......................... son/wife/daughter of shri................................ for the last................... 2
years........................... months and that to the best of my knowledge and belief the particulars by him/her are correct.

Ô©ãã¶ã/Place ÖÔ¦ããàãÀ/Signature..................................
ã䪶ããâ‡ãŠ/Date...................... ¹ãª ¾ãã ÖõãäÔã¾ã¦ã ‚ããõÀ ¹ã¦ãã / Designation or Status and address................................
 ‡ãŠã¾ããÃÊã¾ã ´ãÀã ¼ãÀã •ãã¶ãã Öõ / TO BE FILLED BY THE OFFICE

 ãä¶ã¾ãìãä‡ã‹¦ã ‡ãŠÀ¶ãñ ÌããÊãñ ¹ãÆããä£ã‡ãŠãÀãè ‡ãŠã ¶ãã½ã, ¹ãª¶ãã½ã ¦ã©ãã ¹ãîÀã ¹ã¦ãã / Name, desigantion and full address of the appointing authority.

 ¹ãª ãä•ãÔã‡ãñŠ ãäÊã¾ãñ ¹ãƦ¾ããÍããè ‡ãñŠ ¶ãã½ã ¹ãÀ ãäÌãÞããÀ ãä‡ãŠ¾ãã •ãã ÀÖã Öõ / Post for which the candidate is being considered.