Professional Documents
Culture Documents
AS: J 01 Dgn-2/2016
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AP: 17-12-2016
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Hyderabad Karnataka
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080-30574957/ 080-30574901
0821-2545956
0831-2475345
08472-227944
08182-228099
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21
GOVERNMENT OF KARNATAKA
DEPARTMENT OF SAINIK WELFARE AND RESETTLEMENT
Date:
CERTIFICATE
Place:
Date:
District
22
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23
(Recent Attested
Photograph showing
the disability
affixed here)
Sd/(Doctor)
(Seal)
Sd/(Doctor)
(Seal)
Sd/(Doctor)
(Seal)
Countersigned by the
Medical Superintendent CMO/Head
of Hospital (with seal)
Signature / Thumb impression
of the disabled person
Explanation:-As per Notification No. DPAR 50 SRR 2000 dated 03-09-2005 Physically Handicapped
candidates or person with disability means a person suffering from not less than forty percent of any
of the following disabilities :- (1) Blindness (2) Low Vision (3) Hearing impairment (4) Locomotor disability
(5) Leprosy cured (6) Mental retardation (7) Mental illness.
- (1)Blindness refers to a condition where a person suffers from any of the following conditions, namely:(a)Total absence of sight; or (b) Visual acuity not exceeding 6/60 or 20/200 (Snellen) in the better eye with
correcting lenses; or (c) limitation of the field of vision subtending an angle of 20 degree or worse;(2) Person
with low vision means a person with impairment of visual functioning even after treatment or standard
refractive correction, but who uses or is potentially capable of using vision for the planning or execution of a
task with appropriate assistive device;(3) Hearing impairment means loss of sixty decibels or more in the
better ear in the conversational range of frequencies.(4) Locomotor disability means disability of the bones,
joints or muscles leading to substantial restriction of the movement of the limbs or any form of cerebral
palsy.(5) Leprosy cured:-means any person who has been cured of Leprosy, but is suffering from, (i) Loss of
sensation in hands or feet as well as loss of sensation & paresis in the eye & eyelid, but with no manifest
deformity;(ii)manifest deformity & paresis but having sufficient mobility in their hands & feet to enable
them to engage in normal economic activity; (iii) extreme physical deformity as well as advanced age which
prevents him from undertaking any gainful occupation; and the expressesion Leprosy cured shall be
construed accordingly; (6) Mental Retardation:-means a condition of arrested or incomplete development of
mind of a person who is specially characterised by sub normality of intelligence; (7) Mental Illness:- means
any mental disorder other than mental retardation.
24
CAzs J
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: ______________________
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26
Dr...S/D/W/o aged . .
I state that I am a post graduate degree holder in Ayurveda / Unani / Homoeopathy / Yoga
I further state that I worked as Lecturer / Assistant Professor / Professor. The details of
college, designation, period of working, No.of years of experience are as shown below.
Sl.
No.
3.
Name of the
College /
Institution
No.of
Residential address
years of during the period
experience (produce copy of
document for address
proof)
subject in Ayurveda / Unani / Homoeopathy / Yoga & Naturopathy discipline in the above said
College and have .. years of teaching experience.
[
4.
I state that I have produced the appointment letter, the copy of duty report letter, relieving
I state that I have not submitted my certificates to the college only for the purpose of helping
the college/institution for obtaining permission and affiliation from CCIM/CCH and RGUHS.
27
6.
I have been paid salary for the above period and as a proof I am producing copies of the
I state that during the period of my service in the above institution I have not served
elsewhere or any other organization or institution. I further state that during the above period, I
normally resided in the residential place stated above, and not stayed away from said place for a
long period other than Holidays /
leave. I further state that I was working as a regular employee during the said period and not as
visiting faculty.
8.
I also hereby furnishing form No.16 certificate under section 103 of the Income Tax Act
1961 for tax deducted at source on salary issued by the concerned institution for the purpose of
income tax.
9.
I state that the particulars furnished by me are true and correct and if it is found to be false,
I do solemnly affirm and state on oath that this is my name and signature and the contents
of this affidavit are true and correct to the best of my knowledge, information and belief.
I have sworn to this affidavit on this . day of . 2013.
Identified by me
Advocate
Place
Date
28
AFFIDAVIT-II
(To be sworn to by the Principal of the College / Institution)
I, .. .. .
S/D/W/oaged. about..years, presently residing
atdo hereby solemnly affirm and state on oath as follows:1.
.years.
2.
Sl.
No.
3.
Post/
Designation
Period of
teaching
(month &
year)
Residential address
during the period
(produce copy of
document for proof)
I state that we have issued the appointment letter to the said candidate and also the duty
I further state that Dr. has worked diligently and has taken theory
classes/practical classes regularly and he has also attended hospital duties (both inpatient and
outpatient section regularly) of our college and attached hospital. Necessary records are enclosed
as evidence to show that he / she has worked in our college and hospital on regular basis. These
records are still maintained in our college / institution and are available for verification at any time.
5.
I state that the candidate working regularly in our college during the above said period. He
/ She was drawn average monthly salary of Rs.. including all emoluments. We
have documents to show the disbursement of his / her salary. His / Her salary was deposited to his
/ her bank Account No. of Bank situated in I further
state that I hereby produced the copy of form No.16 certificate under section 103 of the Income
Tax Act 1961 for tax deducted at source on salary issued by the concerned institution for the
purpose of income tax.
29
6.
I certify that the said candidate was residing in the above said place during the service in our
institution / college.
7.
I state that the said candidate is in the acquittance rolls of our college and he / she has not
been appointed only for the sake of getting statistical purposes and for obtaining permission and
affiliation from CCIM and RGUHS, but he / she was teaching regularly in our college.
8.
state that the particulars furnished by me are true and correct to the best of my
knowledge, information and if the contents of the above affidavit are found to be false and
incorrect, I am liable for criminal prosecution and punishment.
I do solemnly affirm and state on oath that this is my name and signature and the contents
of this affidavit are true and correct to the best of my knowledge, information and belief.
I have sworn to this affidavit on this . day of . 2013.
Identified by me
Advocate
Place
Date
30
AFFIDAVIT-III
(To be sworn to by the Management (Secretary / President) of the College / Institution)
I, .
S/D/W/oaged about..years, residing
atdo hereby solemnly affirm and state on oath as follows:1.
.
2.
3.
Post/
Designation
Subject taught
U.G./P.G.
Period of
teaching
(month &
year)
Residential address
during the period
(produce copy of
document for proof)
I state that our college Principal / Management has issued the appointment letter to the said
I state that the said candidate is in the acquittance rolls of our college and he/she has not
been appointed only for the sake of getting statistical purposes and for obtaining permission and
affiliation from CCIM and RGUHS, but he / she was teaching regularly in our college.
5.
I further state that Dr. has worked diligently and has taken theory
classes/practical classes regularly and he has also attended hospital duties (both inpatient and
outpatient section regularly) of our college and attached hospital. Necessary records are enclosed
as evidence to show that he/she has worked in our college and hospital on regular basis. These
records are still maintained in our college / institution and are available for verification at any time.
6.
I state that the candidate working regularly in our college during the above said period. He
/ She was drawn average monthly salary of Rs.. including all emoluments. We
have documents to show the disbursement of his / her salary. His / Her salary was deposited to his
/ her bank Account No. of Bank situated in I further
state that I hereby produced the copy of form No.16 certificate under section 103 of the Income
Tax Act 1961 for tax deducted at source on salary issued by the concerned institution for the
purpose of income tax.
31
7.
I certify that the said candidate was residing in the above said place during the service in
8.
I state that the particulars are true and correct to the best of my knowledge information
and if the contents of the above affidavit are found to be false and incorrect, I am liable for
criminal prosecution and punishment including cancellation of permission from the Government to
our college/Institution to conduct under graduate and post graduation.
I do solemnly affirm and state on oath that this is my name and signature and the contents
of this affidavit are true and correct to the best of my knowledge, information and belief.
I have sworn to this affidavit on this . day of . 2013.
Identified by me
Advocate
Place
Date
32
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Government recognized
University /Institution.
Assistant Engineer
(Civil) in Mahanagara
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Municipal Admn
89(77+12 -HK) posts
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806-807
53
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Principals in Morarji
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respect of
candidates who
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Morarji Desai
and Category-I of other Backward
Residential
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Schools on
Others.
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appointed by
contained in the Karnataka Civil
Karnataka
Services (Direct Recruitment by
Residential
Competitive Examination and
Education
Selection) (General) Rules, 2006 While
preparing the selection list, weightage of Institutions
Society, the
five marks shall be given for each
maximum age
completed year of service subject to a
limit shall be
maximum of twenty five marks in
relaxed by one
respect of candidates appointed by the
year for each
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completed year of
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service subject to
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a maximum
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of five years.
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Officer in the Dept.of
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= 32+01(HK)
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909
67
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Draughtsman in the
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