vkuWykbu foLr`r vkosnu izi=k ds fy, vuqns'kvkuWykbu foLr`r vkosnu izi=k ds fy, vuqns'kvkuWykbu foLr`r vkosnu izi=k ds fy, vuqns'kvkuWykbu foLr`r vkosnu izi=k ds fy, vuqns'kvkuWykbu foLr`r vkosnu izi=k ds fy, vuqns'kGuidelines for Online Detailed Application Form

bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011Engineering Services Examination, 2011

egRoiw.kZegRoiw.kZegRoiw.kZegRoiw.kZegRoiw.kZImportant

1 -1 -1 -1 -1 - mEehnokjks a dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kkmEehnokjks a dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kkmEehnokjks a dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kkmEehnokjks a dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kkmEehnokjks a dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kkdh fu;ekoyh (i z fr l ayXu) ftle s a ik= krk dh 'krk s Z a vkfn dk mYYk s[ k g S ] dk s lko/kuh l s i< + y s a Adh fu;ekoyh (i z fr l ayXu) ftle s a ik= krk dh 'krk s Z a vkfn dk mYYk s[ k g S ] dk s lko/kuh l s i< + y s a Adh fu;ekoyh (i z fr l ayXu) ftle s a ik= krk dh 'krk s Z a vkfn dk mYYk s[ k g S ] dk s lko/kuh l s i< + y s a Adh fu;ekoyh (i z fr l ayXu) ftle s a ik= krk dh 'krk s Z a vkfn dk mYYk s[ k g S ] dk s lko/kuh l s i< + y s a Adh fu;ekoyh (i z fr l ayXu) ftle s a ik= krk dh 'krk s Z a vkfn dk mYYk s[ k g S ] dk s lko/kuh l s i< + y s a A1. Candidates are advised to read carefully the Rules of the Examination, which include conditions ofeligibility etc. as published in the Gazette of India dated 08th January, 2011.

2. mEehnokj ;g lqfuf'pr dj ysa fd vkuWykbu vkosnu izi=k ds lHkh dkWyeks a dks Bhd izdkj ls Hkj fn;k gSaA vkosnumEehnokj ;g lqfuf'pr dj ysa fd vkuWykbu vkosnu izi=k ds lHkh dkWyeks a dks Bhd izdkj ls Hkj fn;k gSaA vkosnumEehnokj ;g lqfuf'pr dj ysa fd vkuWykbu vkosnu izi=k ds lHkh dkWyeks a dks Bhd izdkj ls Hkj fn;k gSaA vkosnumEehnokj ;g lqfuf'pr dj ysa fd vkuWykbu vkosnu izi=k ds lHkh dkWyeks a dks Bhd izdkj ls Hkj fn;k gSaA vkosnumEehnokj ;g lqfuf'pr dj ysa fd vkuWykbu vkosnu izi=k ds lHkh dkWyeks a dks Bhd izdkj ls Hkj fn;k gSaA vkosnuizi=k esa dh xbZ izfof"V;ks a esa ifjorZu laca/h mEehnokjks a ds i=kkpkj ij vk;ksx }kjk fopkj ugha fd;k tk,xkA 'kqU; tkudkjhizi=k esa dh xbZ izfof"V;ks a esa ifjorZu laca/h mEehnokjks a ds i=kkpkj ij vk;ksx }kjk fopkj ugha fd;k tk,xkA 'kqU; tkudkjhizi=k esa dh xbZ izfof"V;ks a esa ifjorZu laca/h mEehnokjks a ds i=kkpkj ij vk;ksx }kjk fopkj ugha fd;k tk,xkA 'kqU; tkudkjhizi=k esa dh xbZ izfof"V;ks a esa ifjorZu laca/h mEehnokjks a ds i=kkpkj ij vk;ksx }kjk fopkj ugha fd;k tk,xkA 'kqU; tkudkjhizi=k esa dh xbZ izfof"V;ks a esa ifjorZu laca/h mEehnokjks a ds i=kkpkj ij vk;ksx }kjk fopkj ugha fd;k tk,xkA 'kqU; tkudkjhdh fLFkfr ds ekeys esa mEehnokj lacf/r dkWye esa Li"V :i ls 'kwU; fy[ks aA dksbZ Hkh dkWye [kkyh u NksMk tk,Adh fLFkfr ds ekeys esa mEehnokj lacf/r dkWye esa Li"V :i ls 'kwU; fy[ks aA dksbZ Hkh dkWye [kkyh u NksMk tk,Adh fLFkfr ds ekeys esa mEehnokj lacf/r dkWye esa Li"V :i ls 'kwU; fy[ks aA dksbZ Hkh dkWye [kkyh u NksMk tk,Adh fLFkfr ds ekeys esa mEehnokj lacf/r dkWye esa Li"V :i ls 'kwU; fy[ks aA dksbZ Hkh dkWye [kkyh u NksMk tk,Adh fLFkfr ds ekeys esa mEehnokj lacf/r dkWye esa Li"V :i ls 'kwU; fy[ks aA dksbZ Hkh dkWye [kkyh u NksMk tk,A

2. Candidates should ensure that all modules of the Online Application Form are filled in correctly . Nocorrespondence will be enteretained by the Commission from candidates to change any of the entries made inthe application form. In case of NIL information, candidates are advised to clearly write NIL or NA or "0" inthe relevant module. No module should be left blank.

3 -3 -3 -3 -3 - 'k S f{kd ;k sX;rk] vk; q] tkfr bR;kfn ls lac a f/r lHkh laxr layXud izi=k ds lkFk yxk fn, tk, aA'k S f{kd ;k sX;rk] vk; q] tkfr bR;kfn ls lac a f/r lHkh laxr layXud izi=k ds lkFk yxk fn, tk, aA'k S f{kd ;k sX;rk] vk; q] tkfr bR;kfn ls lac a f/r lHkh laxr layXud izi=k ds lkFk yxk fn, tk, aA'k S f{kd ;k sX;rk] vk; q] tkfr bR;kfn ls lac a f/r lHkh laxr layXud izi=k ds lkFk yxk fn, tk, aA'k S f{kd ;k sX;rk] vk; q] tkfr bR;kfn ls lac a f/r lHkh laxr layXud izi=k ds lkFk yxk fn, tk, aA3. All relevant enclosures relating to educational qualifications, age, community etc. should be enclosed with the Form.

4-4 -4 -4 -4 - iw.kZ :Ik ls Hkjk gqvk vkosnu izi=k iw.kZ :Ik ls Hkjk gqvk vkosnu izi=k iw.kZ :Ik ls Hkjk gqvk vkosnu izi=k iw.kZ :Ik ls Hkjk gqvk vkosnu izi=k iw.kZ :Ik ls Hkjk gqvk vkosnu izi=k vvvvvafre rkjh[k afre rkjh[k afre rkjh[k afre rkjh[k afre rkjh[k 29.12.2011 rd ;k mlls igys voj lfpo (i- 7)] la?k yksd lsokrd ;k mlls igys voj lfpo (i- 7)] la?k yksd lsokrd ;k mlls igys voj lfpo (i- 7)] la?k yksd lsokrd ;k mlls igys voj lfpo (i- 7)] la?k yksd lsokrd ;k mlls igys voj lfpo (i- 7)] la?k yksd lsokvk;ksx] /kSyiqj gkmQl] 'kkgtgkWa jksM] ubZ fnYyh&110069 dks igqW ap tkuk pkfg,Avk;ksx] /kSyiqj gkmQl] 'kkgtgkWa jksM] ubZ fnYyh&110069 dks igqW ap tkuk pkfg,Avk;ksx] /kSyiqj gkmQl] 'kkgtgkWa jksM] ubZ fnYyh&110069 dks igqW ap tkuk pkfg,Avk;ksx] /kSyiqj gkmQl] 'kkgtgkWa jksM] ubZ fnYyh&110069 dks igqW ap tkuk pkfg,Avk;ksx] /kSyiqj gkmQl] 'kkgtgkWa jksM] ubZ fnYyh&110069 dks igqW ap tkuk pkfg,A

vkosnu izi=k ds fyiQkiQs ij ^bathfu;jh lsok ijh{kk] 2011 ds fy, vkosnu izi=k* fy[ks aA vkosnu izi=k la?k yksdvkosnu izi=k ds fyiQkiQs ij ^bathfu;jh lsok ijh{kk] 2011 ds fy, vkosnu izi=k* fy[ks aA vkosnu izi=k la?k yksdvkosnu izi=k ds fyiQkiQs ij ^bathfu;jh lsok ijh{kk] 2011 ds fy, vkosnu izi=k* fy[ks aA vkosnu izi=k la?k yksdvkosnu izi=k ds fyiQkiQs ij ^bathfu;jh lsok ijh{kk] 2011 ds fy, vkosnu izi=k* fy[ks aA vkosnu izi=k la?k yksdvkosnu izi=k ds fyiQkiQs ij ^bathfu;jh lsok ijh{kk] 2011 ds fy, vkosnu izi=k* fy[ks aA vkosnu izi=k la?k yksdlsok vk;ksx ds dkm.Vj ij nLrh :Ik ls Hkh tek fd;k tk ldrk gSA vk;ksx ds fdlh vU; inkf/dkjh dks tek djkuslsok vk;ksx ds dkm.Vj ij nLrh :Ik ls Hkh tek fd;k tk ldrk gSA vk;ksx ds fdlh vU; inkf/dkjh dks tek djkuslsok vk;ksx ds dkm.Vj ij nLrh :Ik ls Hkh tek fd;k tk ldrk gSA vk;ksx ds fdlh vU; inkf/dkjh dks tek djkuslsok vk;ksx ds dkm.Vj ij nLrh :Ik ls Hkh tek fd;k tk ldrk gSA vk;ksx ds fdlh vU; inkf/dkjh dks tek djkuslsok vk;ksx ds dkm.Vj ij nLrh :Ik ls Hkh tek fd;k tk ldrk gSA vk;ksx ds fdlh vU; inkf/dkjh dks tek djkusds fy, fn, x;s vkosnu izi=kks a ds fy, vk;ksx mRrjnk;h ugha gksxkAds fy, fn, x;s vkosnu izi=kks a ds fy, vk;ksx mRrjnk;h ugha gksxkAds fy, fn, x;s vkosnu izi=kks a ds fy, vk;ksx mRrjnk;h ugha gksxkAds fy, fn, x;s vkosnu izi=kks a ds fy, vk;ksx mRrjnk;h ugha gksxkAds fy, fn, x;s vkosnu izi=kks a ds fy, vk;ksx mRrjnk;h ugha gksxkA

4. The completed application form must reach the Under Secretary (E.VII), Union Public Service Commission,Dholpur House, Shahjahan Road, New Delhi-110069 on or before 29.12.2011

The envelope containing the application form should be superscribed “Detailed Application Form EngineeringServices Examination, 2011.” Application can also be delivered at the Union Public Service Commission counter by hand.The Commission will not be responsible for the application forms delivered to any other functionary of the Commission.

5-5 -5 -5 -5 - mEehnokj vius vkosnu izi=k] mEehnokjh vkfn ds laca/ esa fdlh izdkj ds ekxZn'kZu @lwpuk@Li"Vhdj.k ds laca/mEehnokj vius vkosnu izi=k] mEehnokjh vkfn ds laca/ esa fdlh izdkj ds ekxZn'kZu @lwpuk@Li"Vhdj.k ds laca/mEehnokj vius vkosnu izi=k] mEehnokjh vkfn ds laca/ esa fdlh izdkj ds ekxZn'kZu @lwpuk@Li"Vhdj.k ds laca/mEehnokj vius vkosnu izi=k] mEehnokjh vkfn ds laca/ esa fdlh izdkj ds ekxZn'kZu @lwpuk@Li"Vhdj.k ds laca/mEehnokj vius vkosnu izi=k] mEehnokjh vkfn ds laca/ esa fdlh izdkj ds ekxZn'kZu @lwpuk@Li"Vhdj.k ds laca/ esa la?k yksd lsokesa la?k yksd lsokesa la?k yksd lsokesa la?k yksd lsokesa la?k yksd lsokvk;ksx] ds ifjlj esa xsV lh ds fudV lqfo/k dkm.Vj ij Lo;a vkdj ;k nwjHkki la[;k 011&23385271@011&23381125@vk;ksx] ds ifjlj esa xsV lh ds fudV lqfo/k dkm.Vj ij Lo;a vkdj ;k nwjHkki la[;k 011&23385271@011&23381125@vk;ksx] ds ifjlj esa xsV lh ds fudV lqfo/k dkm.Vj ij Lo;a vkdj ;k nwjHkki la[;k 011&23385271@011&23381125@vk;ksx] ds ifjlj esa xsV lh ds fudV lqfo/k dkm.Vj ij Lo;a vkdj ;k nwjHkki la[;k 011&23385271@011&23381125@vk;ksx] ds ifjlj esa xsV lh ds fudV lqfo/k dkm.Vj ij Lo;a vkdj ;k nwjHkki la[;k 011&23385271@011&23381125@011&23098543 ij dk;Zfnolksa esa izkr% 10-00 cts ls lk;a 17-00 cts ds e?; laidZ dj ldrs gSaA mEehnokj vius lk{kkRdkj011&23098543 ij dk;Zfnolksa esa izkr% 10-00 cts ls lk;a 17-00 cts ds e?; laidZ dj ldrs gSaA mEehnokj vius lk{kkRdkj011&23098543 ij dk;Zfnolksa esa izkr% 10-00 cts ls lk;a 17-00 cts ds e?; laidZ dj ldrs gSaA mEehnokj vius lk{kkRdkj011&23098543 ij dk;Zfnolksa esa izkr% 10-00 cts ls lk;a 17-00 cts ds e?; laidZ dj ldrs gSaA mEehnokj vius lk{kkRdkj011&23098543 ij dk;Zfnolksa esa izkr% 10-00 cts ls lk;a 17-00 cts ds e?; laidZ dj ldrs gSaA mEehnokj vius lk{kkRdkjdk;Zdze] ifj.kke vkfn ds foi; esa vk;ksx ds osCklkbZV (dk;Zdze] ifj.kke vkfn ds foi; esa vk;ksx ds osCklkbZV (dk;Zdze] ifj.kke vkfn ds foi; esa vk;ksx ds osCklkbZV (dk;Zdze] ifj.kke vkfn ds foi; esa vk;ksx ds osCklkbZV (dk;Zdze] ifj.kke vkfn ds foi; esa vk;ksx ds osCklkbZV (Website))))) http: //www.upsc.gov.in ls Hkh tkudkjh izkIr dj ldrs gSA ls Hkh tkudkjh izkIr dj ldrs gSA ls Hkh tkudkjh izkIr dj ldrs gSA ls Hkh tkudkjh izkIr dj ldrs gSA ls Hkh tkudkjh izkIr dj ldrs gSA5. In case of any guidance/information/clarification regarding their applications, candidature etc. candidatescan contact UPSC's Facilitation Counter near Gate ‘C’ of its campus in person or over Telephone No. 011-23385271/011-23381125/011-23098543 on working days between 10.00 hrs. and 17.00 hrs. CANDIDATES CANALSO OBTAIN INFORMATION ABOUT THEIR APPLICATION, INTERVIEW PROGRAMME AND RESULTSETC. ON THE COMMISSION’S WEBSITE AT THE ADDRESS :— http://www.upsc.gov.in

6 -6 -6 -6 -6 - la?k yksd lsok vk;ksx ds ijh{kk Hkouks a ds ifjlj esa eksckbZy iQksu ykus ij izfrca/ gSAla?k yksd lsok vk;ksx ds ijh{kk Hkouks a ds ifjlj esa eksckbZy iQksu ykus ij izfrca/ gSAla?k yksd lsok vk;ksx ds ijh{kk Hkouks a ds ifjlj esa eksckbZy iQksu ykus ij izfrca/ gSAla?k yksd lsok vk;ksx ds ijh{kk Hkouks a ds ifjlj esa eksckbZy iQksu ykus ij izfrca/ gSAla?k yksd lsok vk;ksx ds ijh{kk Hkouks a ds ifjlj esa eksckbZy iQksu ykus ij izfrca/ gSA

6. The mobile phones are banned in the Campus of UPSC Examination Halls.

2923 UPSC/2009

2

la?k yksd lsok vk;ksxla?k yksd lsok vk;ksxla?k yksd lsok vk;ksxla?k yksd lsok vk;ksxla?k yksd lsok vk;ksxbathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011bathfu;jh lsok ijh{kk] 2011

mEehnokjks a dks vkosnu izi=k Hkjus ds ckjs esa vuqns'kmEehnokjks a dks vkosnu izi=k Hkjus ds ckjs esa vuqns'kmEehnokjks a dks vkosnu izi=k Hkjus ds ckjs esa vuqns'kmEehnokjks a dks vkosnu izi=k Hkjus ds ckjs esa vuqns'kmEehnokjks a dks vkosnu izi=k Hkjus ds ckjs esa vuqns'k

1- mEehnokjksa dks pkfg, fd os vkosnu izi=k Hkjus ls igysbu vuqn'kksa dks ?;ku ls i<+ ysaA

2- mEehnokj ;g vo'; ?;ku j[ksa fd mUgsa vkosnu izi=k dksHkjus esa dsoy Hkkjrh; vadks ds varjkZ"V~+h; Lo:Ik dk iz;ksx djukgs tsls 1] 2] 3] 4] 5] 6 bR;kfnA os bl ckjs esa fo'ks"k lko/kuh cjrsafd vkosnu izi=k esa dh xbZ izfof"V;kWa Li"V vkSj lqikB~; gksaA ;fnos izfof"V;ka i<+h ugha tk ldrh gSa ;k Hkzked gsa rks muds fuoZpu esagksus okyh Hkzkafr ;k lafnX/rk ds fy, mEehnokj gh ftEesnkj gksaxsa Ala'kks/u] ;fn dksbZ gks] Li"V gksus pkfg, rFkk mEehnokj }kjkvuqizekf.kr gksus pkfg,A

3- mEehnokjksa ls vuqjks/ gS fd os vkosnu izi=k ds dkye 11esa mu lsokvksa@inksa dks Li"V :i ls fy[k nsa ftuds fy, osojh;rkØe esa fopkj.k pkgrs gSaa mUgsaa lykg nh tkrh gS fd os ftruhpkgsa mruh ojh;rkvksa dk mYys[k dj nsa rkfd ;ksx;rkdze esa mudsjSad dks è;ku esa j[krs gq, fu;qfDr djrs le; mudh ojh;rkvksa ijHkyh Hkkafr fopkj fd;k tk ldsA

fo'ks"k è;ku 1o'ks"k è;ku 1o'ks"k è;ku 1o'ks"k è;ku 1o'ks"k è;ku 1% os foHkkxh; mEehnokj] ftUgsa vk;q lhek esaNwV ds v/hu (nsf[k, fu;e 5 [k) ijh{kk esa Hkkx ysus dh vuqefrnh xbZ gS vU; ea=kky;ksa@foHkkxksa ls lsokvksa@inksa ij fu;qDr fd, tkusds fy, Hkh viuh ojh;rk ns ldrs gSA

fo'ks"k è;ku 2fo'ks"k è;ku 2fo'ks"k è;ku 2fo'ks"k è;ku 2fo'ks"k è;ku 2% fu;e 6 ds mica/ ds varxZr ijh{kk esa izos'kfn, x, mEehnokjksa dh dsoy mUgha ojh;rkvksa ij fopkj fd;ktk,xk tks mDr mica/ esa fufnZ"V inks ads fy, gSa vkSj vU; lsokvksavkSj inks ads fy, mudh ojh;rkvksa] ;fn dksbZ gks ij fopkj ughafd;k tk,xkA

fo'ks"k è;ku 3fo'ks"k è;ku 3fo'ks"k è;ku 3fo'ks"k è;ku 3fo'ks"k è;ku 3% fdlh Hkh mEehnokj dk vius foLr`rvkosnu izi=k esa igys ls fufnZ"V ojh;rkvksa dks c<kus @ifjorZu djusds ckjs esa dksbZ vuqjks/ vk;ksx }kjk Lohdkj ugha fd;k tk,xkA

4- mEehnokj }kjk bl vkosnu izi=k esa nh xbZ lwpuk dhiM+rky bl ijh{kk ds ljyhd`r vkosnu izi=k esa nh xbZ lwpukvksa lsdh tk,xhA xaHkhj folaxfr;kWa ikbZ tkus ij mudh mEehnokjh jn~ndj nh tk,xhA

5- mEehnokj vkosnu izi=k esa fn, x;s LFkku ij Bhdizdkj ls viuk gky gh dk ikliksVZ vkdkj dk ,d iQksVksfpidk,aA iQk sVk s fdlh jktif=kr vf/dkjh vFkok mlegkfo|ky;@ laLFkku tgkW a mEehnokj lcls ckn esa vè;;ujrjgk gks ds izkpk;Z }kjk fof/or~ lR;kfir gksA

6- ;fn dksbZ mEehnokj fdlh vuqlwfpr tkfr @ vuqlwfprtutkfr ;k vU; fiNMh Jsf.k;ks a dk gksus dk nkok djrs gS a rksmls vius nkos ds leFkZu esa ml ftys ds ftlesa mlds ekrkfirk (;k thfor ekrk ;k firk) vkerkSj ls jgrs gks a] ftykvf/dkjh ;k mi eaMy vf/dkjh ;k ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&I esa n'kkZ, x,,sls vU; vf/dkjh ls ftls laca/ jkT; ljdkj us ;g izek.k&i=ktkjh djus ds fy, in ukfer fd;k gks ifjf'k"V&A es a

fn, x;s iQkeZ esa izek.k i=k ysdj mldh vuqizekf.kr@ izekf.krizfrfyfi izLrqr djuh pkfg,A ;fn mEehnokj ds ekrk vkSj firk nksuksadh e`R;q gks xbZ gks rks ;g izek.k i=k ml ftys ds vf/dkjh ls fy;ktkuk pkfg, tgkWa mEehnokj viuh f'k{kk ls fHkUu fdlh vU; iz;kstuls vkerkSj ij jgrk gSA

7- mEehnokj dks bl izi=k ds lkFk ,d ,sls izek.ki=k dhvuqizekf.kr@ izekf.kr izfrfyfi vo'; Hkstuh pkfg, ftlls bl ckrdk izek.k fey lds fd ^^jkstxkj lekpkj** fnukad 08 tuojh2011 esa izdkf'kr mDr ijh{kk ds uksfVl ds iSjk 4(3) esa vksj Hkkjrds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kk dhfu;ekoyh ds fu;e 6 esa izdkf'kr fu/kZfjr 'kSf{kd ;ksx;rk mldsikl gSaA Hkstk x;k izek.k i=k ml vf/dkjh (vFkkZr fo'ofo|ky;;k vU; fdlh ijh{kk fudk;) dk gksuk pkfg, ftlus mls ;ksx;rkfo'ks"k iznku dh gSA

8- mEehnokj dks vk;q izek.k i=k dh ftlesa tUe dh rkjh[kcrkbZ xbZ gks] vuqizekf.kr@izekf.kr izfr vius vkosnu ds lkFk Hkstuhpkfg,A vk;ksx tUe dh og rkjh[k Lohdkj djrk gS tks eSfV~+dqys'ku;k ekè;fed fo|ky; NksMus ds izek.k i=k ;k fdlh Hkkjrh;fo'ofo|ky; }kjk eSfV~+dqys'ku ds led{k ekus x, izek.k i=k ;kfdlh fo'ofo|ky; }kjk vuqjf{kr eSfV~+dqys'ku ds led{k ekus x,izek.k i=k ;k fdlh fo'ofo|ky; }kjk vuqjf{kr eSfV~+dqys'ku dsjftLVj esa ntZ dh xbZ gks vkSj og mn~/j.k fo'ofo|ky; ds leqfprizkf/dkjh }kjk izekf.kr gksaA tks mEehnokj mPPkrj ekè;fed ijh{kk;k mldh led{k ijh{kk mRrh.kZ dj pqdk gS og mPprj ekè;fedijh{kk ;k led{k ijh{kk ds izek.k i=k dh vuqizekf.kr@izekf.krizfrfyfi izLrqr dj ldrk gSA

vk;q ds laca/ esa dksbZ vU; nLrkost tsls tUe dq.Myh] 'kiFki=k uxj fuxe ls rFkk lsok vfHkys[k ls tUe laca/h mn~/j.k rFkk,sls gh vU; izek.k i=k Lohdkj ugha fd, tk,axsA vuqns'kksa ds bl Hkkx esa vk, ^eSfV~+dqys'ku@ mPprj ekè;fedijh{kk izek.k i=k* okD;ka'k ds varxZr mi;qZDr oSdfYid izek.k i=klfEefyr gSA dHkh dHkh eSfV~+dqys'ku@mPprj ek?;fed ijh{kk izek.k i=k esatUe dh rkjh[k ugha gksrh gS ;k vk;q ds dsoy iwjs o"kZ ;k@vkSj eghusgh fn, tkrs gSA ,sls ekeyksa esa mEehnokjksa dks eSfV~+dqys'ku@mPprjekè;fed ijh{kk izek.k i=k ds vfrfjDr ml LkaLFkk ds gSMekLVj@fizafliylss fy, x, izek.k i=k dh vuqizekf.kr@izekf.kr izfrfyfi Hkstuhpkfg, tgkWa ls mlus eSfV~+dqys'ku@mPprj ekè;fed ijh{kk mRrh.kZ dhgksaA bl izek.k i=k esa ml laLFkk ds nkf[kyk jftLVj esa ntZ dh xbZmldh tUe dh rkjh[k ;k okLrfod vk;q fy[kh gksuh pkfg,A mEehnokjks a dks psrkouh nh tkrh gS fd ;fn vkosnu mEehnokjks a dks psrkouh nh tkrh gS fd ;fn vkosnu mEehnokjks a dks psrkouh nh tkrh gS fd ;fn vkosnu mEehnokjks a dks psrkouh nh tkrh gS fd ;fn vkosnu mEehnokjks a dks psrkouh nh tkrh gS fd ;fn vkosnuizi=k ds lkFk bu vuqns'kks a esa ;Fkkfu/kZfjr vk;q dk iwjk izek.kizi=k ds lkFk bu vuqns'kks a esa ;Fkkfu/kZfjr vk;q dk iwjk izek.kizi=k ds lkFk bu vuqns'kks a esa ;Fkkfu/kZfjr vk;q dk iwjk izek.kizi=k ds lkFk bu vuqns'kks a esa ;Fkkfu/kZfjr vk;q dk iwjk izek.kizi=k ds lkFk bu vuqns'kks a esa ;Fkkfu/kZfjr vk;q dk iwjk izek.kugha Hkstk x;k rks mEehnokj dh mEehnokjh jugha Hkstk x;k rks mEehnokj dh mEehnokjh jugha Hkstk x;k rks mEehnokj dh mEehnokjh jugha Hkstk x;k rks mEehnokj dh mEehnokjh jugha Hkstk x;k rks mEehnokj dh mEehnokjh jííííí dj nh tk,xha dj nh tk,xha dj nh tk,xha dj nh tk,xha dj nh tk,xha

fVIi.kh 1fVIi.kh 1fVIi.kh 1fVIi.kh 1fVIi.kh 1& ftl mEehnokj ds ikl i<kbZ iwjh djus ds ckn izkIrekè;fed fo|ky; izek.k i=k gks mls dsoy vk;q lslaca¼ izfof"V okys i"B dh vuqizekf.kr@izekf.kr izfrfyfiHkstuh pkfg,A

2

Union Public Service Commission

ENGINEERING SERVICES EXAMINATION, 2011

Instructions to Candidates for filling in theApplication Form

1. The candidates should read these instructionscarefully before filling in the application form.

2. Candidates must use only International form ofIndian numerals in filling in the application form, e.g.1, 2, 3, 4, 5, 6 etc. They should take special care that theentries made in the application form should be clear andlegible. In case there are any illegible or misleadingentries, the candidates will be responsible for theconfusion and the ambiguity caused in interpreting suchentries. Corrections, if any, should be legible and attestedby the candidates.

3. Candidates are required to specify clearly inColumn 11 of the application form the Services/Posts forwhich they wish to be considered in order of preference.They are advised to indicate as many preferences as theywish to, so that having regard to the rank in the order ofmerit, due consideration can be given to their preferenceswhen making appointment.

N.B. (i)—Departmental candidates admitted to theexamination under age relaxation vide Rule 5(b) may givetheir preferences for the Services/Posts in other Ministries/Departments also.

N.B. (ii)—Candidates admitted to the examinationunder the proviso to Rule 6 will be considered only for theposts mentioned in the said proviso, and their preferencefor other Services and Posts, if any, will be ignored.

N.B. (iii)—No request for addition/alteration in thepreferences indicated by a candidate in his/her applicationwill be entertained by the Commission.

4. The information earlier given by the candidatesin the simplified application form for the Examination willbe cross-checked with the information given by them inthis application form. If there are any serious discrepancies,their candidature will be cancelled.

5. The candidates should paste a recent passport sizephotograph in the space provided for it in the applicationform. The photograph should be duly attested by a GazettedOfficer/Principal of the College/Institution last attended.

6. A candidate who claims to belong to one ofthe Scheduled Castes, the Schedule Tribes or theOther Backward Classes should submit in supportof h i s c la im an a t tes ted /cer t i f ied copy of thecertificate in the form given in Appendix-I fromthe District Officer or the Sub-Divisional Officeror any other officer as indicated in Appendix-I of

the district in which his/her parents (or surviving parent)ordinarily reside. Such an officer should have been designatedby the State Government concerned as competent to issue sucha certificate. If both his/her parents are dead, the officersigning the certificate should be of the district in which thecandidate himself/herself ordinarily resides otherwise thanfor the purpose of his/her own education.

7. A candidate must submit alongwith his/her applicationan attested/certified copy of a certificate showing his/hereducational qualification prescribed in para 3(III) of the Noticefor the Examination published in the Employment News dated08th January, 2011 and in Rule 6 of the Rules for theExamination published in the Gazette of India dated 08thJanuary, 2011. The certificate submitted must be one issuedby the authority (i.e. University or other examining body)awarding the particular qualification.

8. A candidate must enclose with his/her application anattested/certified copy of certificate of age (indicating his/her date of birth). The date of birth accepted by the Commissionis that entered in the Matriculation or Secondary SchoolLeaving Certificate or in a certificate recognised by an IndianUniversity as equivalent to Matriculation or in an extract froma Register of Matriculates maintained by a University and thatextract must be certified by the proper authority of theUniversity. A candidate who has passed the Higher SecondaryExamination or an equivalent Examination may submit anattested/certified copy of the Higher Secondary Examinationcertificate or an equivalent certificate.

No other document relating to age like horoscopes,affidavits, birth extracts from Municipal Corporation, ServiceRecords and the like, will be accepted.

The expression Matriculation/Higher SecondaryExamination certificate in this part of the instruction includesthe alternative certificate mentioned above.

Sometimes the Matriculation/Higher SecondaryExamination Certificate does not show the date of birth oronly shows the age by completed years or completed yearsand months. In such cases a candidate must send in addition tothe Matriculation/Higher Secondary Examination Certificatean attested/certified copy of the certificate from theHeadmaster/Principal of the Institution from where he/shepassed the Matriculation/Higher Secondary Examinationshowing date of his/her birth or his/her exact age as recordedin the Admission Register of the Institution.

Candidates are warned that unless complete proofof age as laid down in these instructions is sent with theapplication, the candidature of the candidate will berejected.

Note 1: A candidate who holds a completed Secondary SchoolCertificate need submit an attested/certified copy ofthe page containing entries relating to age only.

2

fVIi.kh 2 & mEehnokj ;g ?;ku j[ksa fd vk;ksx mEehnokj dh tUedh mlh rkjh[k dks Lohdkj djsxk tks vkosnu i=kizLrqr djus dh rkjh[k dks eSfV~+dqys'ku@mPprj ekè;fedijh{kk izek.k i=k ;k led{k ijh{kk ds izek.k i=k esa ntZgS vkSj blds ckn mlesa ifjorZu ds fdlh vuqjks/ ij urks fopkj fd;k tk,xk vkSj u gh mls Lohdkj fd;ktk,xkA

fVIi.kh 3 & mEehnokj ;g Hkh uksV dj ysa fd muds }kjk fdlhijh{kk esa izos'k ds fy, tUe dh rkjh[k ,d ckj ?kksf"krdj nsus vkSj vk;ksx }kjk mls vius vfHkys[k esa ntZ djysus ds ckn mlesa ckn esa ;k ckn dh fdlh ijh{kk esafdlh Hkh vk/kj ij ifjorZu djus dh vuqefr ugha nhtk,xhA

9- (1) tEew ,oa d'ehj jkT; ds vf/oklh ds :Ik esa vk;q esaNwV ds ykHk dk nkok djus okys mEehnokj dks ml ftyk eftLV~+sVls] ftlds {ks=kkf/dkj esa og lkekU;r% jgk gS ;k tEew ,oa d'ehjljdkj }kjk mlds LFkku ij ukfer fdlh vU; izkf/dkjh ls blvk'k; ds izek.k i=k dh vuqizekf.kr@ lR;kfir izfr izLrqr djuh gksxhfd igyh tuojh 1980 ls 31 fnlEcj] 1989 rd dh vof/ dsnkSjku og lkekU;r% tEew ,oa d'ehj jkT; esa gh jgk gSA

(2) vk;q esa NwV pkgus okys ,sls mEehnokj dks tks j{kklsokvksa esa dk;Z djrs gq, fodykax gqvk gS] egkfuns'kd] iqu%LFkkiuk] j{kk ea=kky; ls ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&II esa fn, x, iQkeZ ij blvk'k; dk ,d izek.k i=k ysdj bldh ,d vuqizekf.kr@ izekf.krizfrfyfi izLrqr djuh gksxh fd og j{kk lsokvksa esa dk;Z djrs gq,]fons'kh 'k=kq ns'k ds lkFk la?k"kZ esa vFkok v'kkafrxzLr {ks=k esa iQkSthdk;Zokgh ds nkSjku fodykax gqvk vkSj ifj.kkeLo:Ik fueqZDr gqvkA

(3) vk;q esa NwV dk nkok djus okys HkwriwoZ lSfud] deh'kaMvf/dkjh vkSj bZ- lh- vks-@,l- ,l- lh- vks- lfgr tSlk muds viusekeys esa visf{kr gS] izek.k i=k dh vuqizekf.kr@izekf.kr izfrfyfi]laca/ izkf/dkfj;ksa ls ysdj ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&III esa fn, x, iQkeZ esa izLrqrdjsaA

(4) fu;e 5 ([k) ds varxZr vk;q lhek esa NwV ds fy, nkokdjus okys ljdkjh deZpkfj;ksa dks vius foHkkx@dk;kZy; ds v?;{kls ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&IV esa fn, x, iQkeZ esa izek.k i=k dh ewy izfr izLrqrdjuh pkfg,A

10- tks mEehnokj 'kkjhfjd :Ik ls v{ke gksus dk nkok djrkgS mls lacaf/r lsok@inksa ij dk;Z fu"iknu gsrq] ,d ;k vf/d'kkjhfjd vis{kkvksa@{kerkvksa tSlk fd bathfu;jh lsok ijh{kk] 2011dh fu;ekoyh ds fu;e 19 esa fn;k x;k gS dks iwjk djuk gksxkA mlsljdkjh vLirky@fpfdRlk cksMZ ds }kjk ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&V esa fn, x,izk:Ik esa tkjh izek.k i=k dh ,d izekf.kr izfr izLrqr djuh gksxhA

11- mEehnokj ;g ?;ku j[k s a fd b ath fu;jh l so kijh{ k k ] 2011 e s a mudh mEehnokj h i w. k Z r% vu a fre g SrF k k mud s fu/k Z f jr ik= kr k dh 'kr k s Z a dk s i w j k dju s ijvk/kfjr g S A ;fn fyf[kr ijh{k k rFk k lk{k k Rdkj ijh{k.k

ds igys ;k ckn esa fdlh Lrj ij tkWap djus ij ;g ik;k x;k fdos ik=krk dh fdUgha 'krksZa dks iwjk ugha djrs rks mudh mEehnokjhvk;ksx }kjk jí dj nh tk,xhA

12- mEehnokjksa dks vius vkosnu i=kksa ds lkFk fuEufyf[krizys[k vuqyXu dj vk;ksx dks Hkstus gSa%&

(1) vk;q ds izek.k i=k dh ,d vuqizekf.kr@izekf.kr izfrfyfiA

(2) 'kSf{kd ;ksX;rk ds izek.k i=k dh ,d vuqizekf.kr@izekf.krizfrfyfiA

(3) vuqlwfpr tkfr@vuqlwfpr tutkfr@vU; fiNMh Jsf.k;ksads gksus dk nkok djus ds leFkZu esa izek.k i=k dh,d vuqizekf.kr@izekf.kr izfrfyfi (tgkWa dgha ykxwgks)A

(4) vk;q esa NwV ds nkos ds leFkZu esa izek.k i=k dh ,dvuqizekf.kr@izekf.kr izfrfyfi (tgkWa dgha ykxw gks)A

(5) 'kkjhfjd v{kerk ds MkDVjh izek.k i=k dh vuqizekf.kr@izekf.kr izfrfyfi (tgkWa ykxw gks)A

(6) yxHkx 11-5 ls-eh- x 27-5 ls-eh- vkdkj ds fcukfVdV yxs nks fyiQkiQs ftu ij irk fy[kk gksA mEehnokjdks fyiQkiQksa ij viuk Mkd dk iwjk irk vFkkZrmEehnokj dk uke] edku uEcj] okMZ uEcj] eksgYykvkfn Li"V :Ik ls fy[kuk pkfg,A ,sls ekeyksa esatgkWa edku uEcj u gk]s mEehnokj dks viuk ukefy[kus ds ckn vius firk dk uke rFkk Mkd irk HkhfyiQkiQksa ij fy[kuk pkfg,A

miq;qZDr izek.k&i=k ewy :Ik esa lk{kkRdkj ds le; izLrqr djus gksaxsA

fVIi.kh%& mEehnokjksa ls ;g vis{kk dh tkrh gS fd os vkosnu i=kds lkFk Hksts tkus okys izek.k&i=kksa dh vuqizekf.kr@izekf.kr izfrfyfi;ksa ij vius gLrk{kj djsa rFkk rkjh[k Hkhfy[ksaA

13- ftu ekeyksa esa vkosnu i=k lc vuqyXudksa jfgr ;k dqNvuqyXudksa lfgr izkIr gksaxs muesa mEehnokjh jn~n dj nh tk,xhAmEehnokj ;fn xk;c vuqyXudksa dks ckn esa Hkstrs gsa rks mUgsa Lohdkjugha fd;k tk,xkA mEehnokj ;g vo'; lqfuf'pr dj ysa fdvkosnu&i=k Bhd ls Hkjk x;k gS vkSj mlds lkFk lHkh laxrvuqyXud Hksts x, gSaA vkosnu izi=k dk dksbZ Hkh dkye fjDr uNksM+k tk,A

14- mEehnokj vius vkosnu ds lac/ esa vk;ksx dks tks i=kHkstsa muesa ijh{kk dk uke] viuk iwjk uke] vuqØekad rFkk tUe dhrkjh[k vo'; fy[ksaA

15- mEehnokjksa }kjk vkosnu izi=k ds fofHkUu dkyeksa esa Hkjstkus okyh dksM la[;k,a ekxZn'kZu ladsr (vuqca/) esa nh xbZ gSaAtgka dgha Hkh lwpuk dksM la[;k esa visf{kr gS ogka os mfpr dksMla[;k dk mYys[k djsaA ,sls dkyeksa esa dksM la[;k ds vykok nh xbZvU;Fkk lwpukvksa ij dksbZ è;ku ugha fn;k tk,xkA

3

Note 2 : Candidates should note that only the date of birthas recorded in the Matriculation/Higher Sec-ondary Examination Certicate or an equivalent cer-tificate on the date of submission of applicationwill be accepted by the Commission and no subse-quent request for its change will be considered orgranted.

Note 3 : Candidates should also note that once date of birthhas been claimed by them and entered in the recordsof the Commission for the purpose of admissionto an examination, no change will be allowedsubsequently or at a subsequent examination on anyground whatsoever.

9 (i) A candidate claiming age-relaxation as adomicile of the State of Jammu and Kashmir shouldproduce an attested/certified copy of a certificate from theDistrict Magistrate in the State of Jammu and Kashmirwithin whose jurisdiction he/she had ordinarily resided orfrom any other authority designated in that behalf by theGovernment of Jammu and Kashmir to the effect that he/she had ordinarily been domiciled in the State of Jammuand Kashmir during the period from the 1st January, 1980to the 31st day of December, 1989.

(ii) A candidate disabled while in the Defence Servicesclaiming age concession should produce an attested/certifiedcopy of the certificate in the form given in Appendix -II,from the Director General Resettlement, Ministry ofDefence to show that he/she was disabled while in theDefence Services in operations during hostilities with anyforeign country or in a disturbed area and released as aconsequence thereof.

(iii) Ex-servicemen including Commissioned Officersand ECOs/SSCOs claiming age concession should producean attested/certified copy of the certificate as applicable tothem, in the form given in Appendix-III, from the authoritiesconcerned.

(iv) A Government Servant claiming age concessionunder rule 5(b) should submit a certificate in Original fromthe Head of the Department/Office in the format given inAppendix-IV.

10. A candidate claiming to belong to physicallydisabled category shall be required to meet one or more ofthe physical requirement/abilities, as laid down in Rule 19of the Rules for the Engineering Services Examination,2011, for performing the duties in the concerned Services/Posts. He/She must submit a certified copy of the certificateissued by Government Hospital/Medical Board in the formatgiven in Appendix-V.

11. The candidates should note that their candidaturefor the Engineering Services Examination, 2011, will be purelyprovisional, subject to their satisfying the prescribed eligibilityconditions. If on verification at any stage before or after theexamination it is found that they do not fulfil any of theeligibility conditions, their candidature for the examinationwill be cancelled by the Commission.

12. Enclosures to the application form to be sent tothe Commission by the candidates are as follows :—

(i) An attested/certified copy of the certificate of age.

(ii) An attested/certified copy of the certificate ofeducational qualification indicating the subjects.

(iii) An attested/certified copy of the certificate insupport of claim to belong to Scheduled Castes/Scheduled Tribes/Other Backward Classes(wherever applicable).

(iv) Undertaking by the candidate seeking relaxationas OBC candidate in support of claim of notbelonging to creamy layer, to be given in formatas mentioend in para-B-1 of Appendix-I.

(v) An attested/certified copy of certificate in supportof claim for age concession (whereverapplicable).

(vi) An Attested/certified copy of certificate insupport of claim to being physically handicapped(wherever applicable).

(vii) Two self addressed and unstamped envelopes of11.5 × 27.5 cms. size. Candidates should writeneatly his/her complete postal address i.e. his/herName, House No., Ward No., Mohalla etc. on theenvelopes. In case where House No., is not there,the candidate should write his/her own full name,followed by his/her father’s name with postaladdress on the envelopes.

Originals of the above certificates are required tobe produced at the time of interview.

NOTE :—Candidates are required to sign the attested/certified copies of all certificates sent along with theapplication form and also to put the date.

13. Any application received without all or some ofthe enclosures will entail cancellation of candidature. Anymissing enclosures sent subsequently by the candidate willnot be entertained. The candidates must ensure that theapplication form is properly filled in and is accompanied byall the relevant enclosures. No column of application shouldbe left blank.

14. In all communications with the Commissionregarding this application, the candidate should mention thename of Examination, his full name, Roll Number and dateof birth.

15. Code Numbers to be filled in by the candidates invarious columns of the application form are given in theGuidelines for filling up the Application Form which isAnnexe showing. Wherever information is required to begiven in Code Nos., appropriate Code Nos. may be filled in.Information given in such columns otherwise than in codes,will not be taken into consideration.

3

4

ifjf'k"V&1ifjf'k"V&1ifjf'k"V&1ifjf'k"V&1ifjf'k"V&1

(d) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus(d) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus(d) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus(d) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus(d) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djusokys vuqlwfpr tkfr vkSj vuqlwfpr tutkfr ds mEehnokjks aokys vuqlwfpr tkfr vkSj vuqlwfpr tutkfr ds mEehnokjks aokys vuqlwfpr tkfr vkSj vuqlwfpr tutkfr ds mEehnokjks aokys vuqlwfpr tkfr vkSj vuqlwfpr tutkfr ds mEehnokjks aokys vuqlwfpr tkfr vkSj vuqlwfpr tutkfr ds mEehnokjks a}kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZA}kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZA}kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZA}kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZA}kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZA

izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh·--------------------------------------------------------------------------------------------------------lqiq=k@ lqiq=kh·

Jh ---------------------------------------------------------------------------tks xkWao@ dLck·

-----------------------------------------------------------------------------------------------ftyk@eaMy· -----------------------------------------------------------jkT;@la?k jkT;{ks=k· ---------------------------- ds@dh· fuoklh gS ----------------------------------------------------- tkfr@tutkfr· ds@dh· gS ftls fuEufyf[kr ds v/hu vuqlwfpr tkfr@vuqlwfpr tutkfr ds :Ik esa ekU;rk nh xbZ gS%&

lafo/ku (vuqlwfpr tkfr;ka) vkns'k] 1950@

lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] 1950@

lafo/ku (vuqlwfpr tkfr;ka) (la?k jkT; {ks=k) vkns'k] 1951@

lafo/ku (vuqlwfpr tutkfr;ka) (la?k jkT; {ks=k) vkns'k]1951@

[vuqlwfpr tkfr;ka vkSj vuqlwfpr tutkfr;ka lwph (la'kks/u) vkns'k] 1956] cEcbZ iquxZBu vf/fu;e] 1960] iatkc iquxZBuvf/fu;e] 1966] fgekpy izns'k jkT; vf/fu;e] 1970] mRrjiwohZ {ks=k (iquxZBu) vf/fu;e 1971] vuqlwfpr tkfr;ka vkSjvuqlwfpr tutkfr;ka (la'kks/u) vf/fu;e] 1976] fetksje jkT;vf/fu;e] 1986] v:.kkpy izns'k jkT; vf/fu;e] 1986 rFkkxksok] neu vkSj nho (iquxZBu) vf/fu;e] 1987 }kjk ;Fkkla'kksf/r]

lafo/ku (tEew vkSj d'ehj) vuqlwfpr tkfr;ka vkns'k] 1956@lafo/ku (v.Meku vkSj fudksckj }hi lewg) vuqlwfpr

tutkfr;ka vkns'k] 1959] vuqlwfpr tkfr;ka rFkk vuqlwfpr tutkfr;ka(la'kks/u) vf/fu;e] 1976 }kjk ;Fkk la'kksf/r @

lafo/ku (nknjk vkSj ukxj gosyh) vuqlwfpr tkfr;kavkns'k] 1962@

lafo/ku (nknjk vkSj ukxj gosyh) vuqlwfpr tutkfr;ka]vkns'k] 1962@

lafo/ku (ikafMpsjh) vuqlwfpr tkfr;ka vkns'k] 1964@lafo/ku (mRrj izns'k) (vuqlwfpr tkfr;ka) vkns'k] 1967@lafo/ku (xksok] neu vkSj nho) vuqlwfpr tkfr;ka vkns'k]

1968@lafo/ku (xksok] neu vkSj nho) vuqlwfpr tutkfr;ka

vkns'k] 1968@lafo/ku (ukxkyS.M) vuqlwfpr tutkfr;ka vkns'k] 1970@lafo/ku (flfDde) vuqlwfpr tkfr;ka vkns'k] 1978@lafo/ku (flfDde) vuqlwfpr tutkfr;ka vkns'k] 1978@lafo/ku (tEew vkSj d'ehj) vuqlwfpr tutkfr;ka vkns'k]

1989@lafo/ku (vuqlwfpr tkfr;ka) vkns'k] (la'kks/u) vf/fu;e]

1990@lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] (la'kks/u) vf/fu;e

1991@

lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] (f}rh; la'kks/u)

vf/fu;e 1991@

vuqlwfpr tkfr;ka rFkk vuqlwfpr tutkfr;ka vkns'k (la'kks/u)vf/fu;e] 2002@

lafo/ku (vuqlwfpr tkfr;ka) vkns'k (la'kks/u) vf/fu;e] 2002@

lafo/ku (vuqlwfpr tkfr;ka rFkk vuqlwfpr tutkfr;ka) vkns'k(la'kks/u) vf/fu;e] 2002@

lafo/ku (vuqlwfpr tkfr;ka) vkns'k (f}rh; la'kks/u) vf/fu;e]2002@

»2- vuqlwfpr tkfr;ksa@vuqlwfpr tutkfr;ksa ds ,sls O;fDr;ksads ekeys esa ykxw tks ,d jkT;@la?k jkT; {ks=k iz'kklu ls nwljs jkT;@la?k jkT; {ks=k iz'kklu esa izoztu dj pqds gSaA

;g izek.k i=k Jh@Jherh@dqekjh· ----------------------------------xzke@dLck· -----------------------------------------------------------------ftyk@eaMy·-------------------------------------------------------------------------- jkT; @la?k jkT;{ks=k· --------------------------------------- tks ---------------------------------------------tkfr@tutkfr· ls lEc¼ gS ftls --------------------------------------------------------------------------jkT;@la?k jkT; {ks=k· esa vuqlwfpr tkfr@vuqlwfprtutkfr· ds :Ik esa ekU;rk izkIr gS ds firk@ekrk Jh@Jherh· ---------------------------------------------------- dks tkjh izek.k i=k ds vk/kj ijtkjh fd;k tkrk gSA

fnukad --------------------------------------------------- ds }kjk tkjhA»3- Jh@Jherh@dqekjh· ------------------------------------------------------

vkSj@;k· mudk ifjokj vke rkSj ij@ls xkWao@dLck· ----------------------------------------- ftyk@eaMy· -------------------------------------- jkT;@la?k jkT;{ks=k· ---------------------------------------------------------------esa jgrs@jgrh gS

gLrk{kj

··inuke

(dk;kZy; dh eksgj lfgr)jkT;·@la?k jkT; {ks=k·

LFkku· ------------------------------------rkjh[k --------------------------------·tks 'kCn ykxw u gksa mUgsa dkV nsaA

@d`i;k jkIV~+ifr dk fof'k"V vkns'k fufnZ"V djsAa

» tks iSjk ykxw u gks mls dkV nsaA

fVIi.kh fVIi.kh fVIi.kh fVIi.kh fVIi.kh & ;gkWa ^^vkerkSj ls jgrs@jgrh gSa** dk vFkZ ogh gksxk tksfjisztsUVs'ku vkiQ fn ihiy ,DV] 1950 dh /kjk 20 esa gSA

··vuqlwfpr tkfr@vuqlwfpr tutkfr@vU; fiNM+h Jsf.k;ksadk izek.k i=k tkjh djus ds fy, l{ke izkf/dkfj;ksadh lwphA

(1) ftyk eftLVs~+V@vfrfjDr ftyk eftLVs~+V@dysDVj@fMIVhdfe'uj@,Mh'kuy fMIVh deh'uj@fMIVh dysDVj@izFkeJs.kh dk LVkbZisUMjh eftLVs ~ +V@†lc fMfotuyeftLVs+~V@rkyqdk eftLVs~+V@,DthD;wfVo eftLVs~+V@,DLV~+kvfLkLVsUV deh'ujA

† (izFke Js.kh ds LVkbisUMjh eftLVs~+V ls de jSad dk u gks)

4

APPENDIX-1

(A) The form of certificate to be produced by ScheduledCastes and Scheduled Tribes candidates applying forappointment to posts under the Government of India.

This is to certify that Shri/Shrimati/Kumari* .................................................. son/daughter* of .....................................................of village/town* ................................................. in District/Division* ........................................... of the State/UnionTerritory* ...................... belongs to the..........................caste/tribe* which is recognised as a Scheduled Caste/Scheduled 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 TribesList (Modification) Order, 1956; the Bombay ReorganisationAct, 1960, the Punjab Reorganisation Act, 1966, the State ofHimachal Pradesh Act, 1970, the North Eastern Areas(Reorganisation) Act, 1971, the Scheduled Castes andScheduled Tribes Order (Amendment) Act, 1976., the State ofMizoram Act, 1986, the State of Arunachal Pradesh Act, 1986and the Goa, Daman and Diu (Reorganisation) Act, 1987.]

the Constitution (Jammu and Kashmir) Scheduled CastesOrder, 1956@.

the Constitution (Andaman and Nicobar Islands) ScheduledTribes Order, 1959 as amended by the Scheduled Castes andScheduled Tribes Order (Amendment) Act, 1976. @

the Constitution (Dadar and Nagar Haveli) Scheduled CastesOrder, 1962.@

the Constitution (Dadar and Nagar Haveli) Scheduled TribesOrder, 1962.@

the Constitution (Pondicherry) Scheduled Castes Order,1964.@

the Constitution (Uttar Pradesh) Scheduled Tribes Order,1967.@

the Constitution (Goa, Daman and Diu) Scheduled CastesOrder, 1968.@

the Constitution (Goa, Daman and Diu) Scheduled TribesOrder, 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 & 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 (SecondAmendment) Act, 2002@

% 2. Applicable in the case of Scheduled Castes/ScheduledTribes persons who have migrated from one State/UnionTerritory Administration to another.

This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes certificate issued to Shri/Shrimati*..............

....................................... Father/Mother of Shri/Shrimati/Kumari ................................................... of village/town*.......................................... in District/Division*............................of the State/Union Territory*............................ who belongs tothe caste/tribe* which is recognised as a Scheduled Caste/Scheduled Tribe in the State/Union Territory* of ..................................... issued by the .....................................

dated ......................................

% 3. Shri/Shrimati/Kumari* ...............................................and/or* his/her* family ordinarily reside(s) in village/town*............................. of .............................. District/Division*of the State/Union Territory* of ..............................................

Signature ................................................

**Designation............................................

(With Seal of Office)State/Union Territory*

Place : .....................................

Date : ......................................

*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 havethe same meaning as in Section 20 of theRepresentation of the People Act, 1950.

**List of authorities empowered to issue ScheduledCaste/Scheduled Tribe/OBC Certificates.

(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional DeputyCommissioner/Deputy Collector/1st Class StipendiaryMagistrate/† Sub-Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner.

†(not below of the rank of 1st Class StipendiaryMagistrate).

(2) phiQ izslhMsUlh eftLVs~+V@,Mh'kuy phiQ iszlhMsUlh eftLVs~+V@izslhMsaUlh eftLVs~+VA

(3) jsosU;w viQlj ftldk vksgnk rglhynkj ls de u gksA

(4) ml bykds dk lc fMohtuy vkfiQlj tgka mEehnokjvkSj@;k mldk ifjokj vkerkSj ls jgrk gksA

([k) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus([k) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus([k) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus([k) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djus([k) Hkkjr ljdkj ds inks a ij fu;qfDr ds fy, vkosnu djusokys vU; fiNMs oxks Z a ds mEehnokjks a }kjk izLrqr fd, tkusokys vU; fiNMs oxks Z a ds mEehnokjks a }kjk izLrqr fd, tkusokys vU; fiNMs oxks Z a ds mEehnokjks a }kjk izLrqr fd, tkusokys vU; fiNMs oxks Z a ds mEehnokjks a }kjk izLrqr fd, tkusokys vU; fiNMs oxks Z a ds mEehnokjks a }kjk izLrqr fd, tkusokys izek.ki=k dk iQkeZAokys izek.ki=k dk iQkeZAokys izek.ki=k dk iQkeZAokys izek.ki=k dk iQkeZAokys izek.ki=k dk iQkeZA

izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh· ---------------lqiq=k@lqiq=kh· Jh ------------------------------------------------------------------- tksftyk@eaMy· ------------------------------------------------------------------------------ dsxkWao@dLck· -------------------------------jkT;@la?k ------------------------- jkT;{ks=k· -------------------------------------------------------------- ds@dh· fuoklh gSa---------------------------- ds leqnk; ds gSa ftls fuEufyf[kr ds v/hufiNMs+ oxZ ds :Ik esa ekU;rk feyh gS%&

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k186 esa fnukad 13 flrEcj] 1993 dks izdkf'kr Hkkjr ljdkj]dY;k.k ea=kky; ds fnukad 10 flrEcj] 1993 dk ladYi la-12011@68@93&ch-lh-lh-(lh)A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k163 esa fnukad 20 vDrwcj] 1994 dks izdkf'kr Hkkjr ljdkj]dY;k.k ea=kky; ds fnukad 19 vDrwcj] 1994 dk ladYi la-12011@9@94&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 88esa fnukad 25 ebZ] 1995 dks izdkf'kr Hkkjr ljdkj] dY;k.k ea=kky;ds fnukad 24 ebZ] 1995 ds ladYi la- 12011@7@95&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 60esa fnukad 11 ekpZ] 1996 dks izdkf'kr Hkkjr ljdkj] dY;k.kea=kky; ds fnukad 9 ekpZ] 1996 dk ladYi la- 12011@96@94&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k210 esa fnukad 11 fnlEcj] 1996 dks izdkf'kr Hkkjr ljdkj]dY;k.k ea=kky; dk fnukad 6 fnlEcj] 1996 dk ladYi la-12011@44@96&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k236 esa fnukad 12 fnlEcj] 1997 dks izdkf'kr Hkkjr ljdkj]dY;k.k ea=kky; ds fnukad 11 fnlEcj] 1997 dk ladYi la-12011@99@94&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k239 esa fnukad 17 fnlEcj] 1997 dks izdkf'kr Hkkjr ljdkj]dY;k.k ea=kky; dk fnukad 3 fnlEcj] 1997 dk ladYi la-12011@13@97&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k241 esa fnukad 27 vDrwcj] 1999 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; ,oa vf/dkfjrk ea=kky; ds fnukad 27 vDrwcj]1999 dk ladYi la- 12011@68@98&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k270 esa fnukad 6 fnlEcj] 1999 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; ,oa vf/dkfjrk ea=kky; ds fnukad 6 fnlEcj] 1999ds ladYi la- 12011@88@98&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 71esa fnukad 4 vizSy] 2000 dks izdkf'kr Hkkjr ljdkj] lkekftd U;k;vkSj vf/dkfjrk ea=kky; dk fnukad 4 vizSy] 2000 dk ladYi la-12011@36@99&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k210 esa fnukad 21 flrEcj] 2000 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 21 flrEcj]2000 dk ladYi la- 12011@44@99&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k246 esa fnukad 6 flrEcj] 2001 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; vkSj vf/dkfjrk ea=kky; dk fnukad 6 flrEcj]2001 dk ladYi la- 12015@9@2000&ch-lh-lh-A

@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]la[;k 151 esa fnukad 20 twu] 2003 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; vkSj vf/dkfjrk ea=kky; dks fnukad 19 twu] 2003ds ladYi la- 12011@1@2001&ch-lh-lh-A

@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]la[;k 9 esa fnukad 13 tuojh] 2004 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 13 tuojh]2004 dk ladYi la- 12011@4@2002&ch-lh-lh-A

@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]la[;k 10 esa fnukad 16 tuojh] 2006 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 16 tuojh]2006 dk ladYi la- 12011@9@2004&ch-lh-lh-A

@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]la[;k 67 esa fnukad 12 ekpZ] 2007 dks izdkf'kr Hkkjr ljdkj]lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 12 ekpZ] 2007dk ladYi la- 12011@14@2004&ch-lh-lh-AJh@Jherh@dqekjh· ---------------------------------------------- vkSj@;k· mudkifjokj lkekU;rk ftyk@e.My· -------------------------- ds xkao@dLck·-------------------------------------- jkT;@la?k jkT; {ks=k· esa fuokl djrs gSaA

;g Hkh izekf.r fd;k tkrk gSa fd ;g· dkfeZd rFkkizf'k{k.k foHkkx] Hkkjr ljdkj ds fnukad 8-9-1993 ds dk;kZy;Kkiu la[;k 36012@22@93&LFkk- (,l-lh-Vh-) fnukad 9-3-2004 dsdk- Kk- la- 36033@3@2004&LFkk-(vkj{k.k) dh vuqlwph ds dkye3 es a fn, x, O;fDr;ks a@oxk s Z a· rFkk dk;k Zy; Kkiu la-36033@3@2004&LFkk- (vkj{k.k) fnukad 14-10-2008 (lEiUu vFkkZrØheh ys;j ls) lacfU/r ugha gSA

gLRkk{kj ---------------------------··inuke ------------------------

(dk;kZy; dh eksgj)jkT;@la?k jkT; {ks=k

LFkku % -----------------------------fnukad% ---------------------------·tks 'kCn ykxw u gks mUgsa dkV nsaA@tks ykxw u gks mUgsa dkV nsaA

fVIi.khVIi.khVIi.khVIi.khVIi.kh%& ;gka ^^vkerkSj ls jgrs@jgrh gSa** dk vFkZ ogh gksxk tksfjizstsUVs'ku vkiQ fn ihiy ,DV 1950 dh /kjk 20 esa gSA

··vU; fiNMs oxZ (vks-ch-lh-) dk izek.k i=k tkjh djusds fy, l{ke izkf/dkjh ogh jgsaxs tks v-tk-@v-t-tk-ds izek.k i=k tkjh djus ds fy, l{ke gSaA

5

(ii) Chief Presidency Magistrate/Additional ChiefPresidency Magistrate/Presidency Magistrate.

(iii) Revenue Officers not below the rank of Tehsildar.

(iv) Sub Divisional Officer of the area where the candidateand/or his/her family normally resides.

(B) The form of certificate to be produced by OtherBackward Classes candidates applying for appointment toposts under the Government of India.

This is to certify that Shri/Shrimati/Kumari*...........................................son/daughter* of Shri............................... ofvillage/town* ...........................in District/Division*............... ofthe State/Union Territory*..................................belongs to the....................Community which is recognised as a backwardclass under :

@ Government of India, Ministry of Welfare ResolutionNo. 12011/68/93-BCC (C) dated 10th September, 1993 publishedin the Gazette of India Extraordinary Part-I, Section-1, No. 186dated 13th September, 1993.

@ Government of India, Ministry of Welfare ResolutionNo. 12011/9/94-BCC dated 19-10-94, published in the Gazetteof India Extraordinary Part-I, Section-1, No. 163 dated20-10-1994.

@ Government of India, Ministry of Welfare ResolutionNo. 12011/7/95-BCC dated 24-5-95, published in the Gazette ofIndia Extraordinary Part-I, Section-1, No. 88 dated25-5-1995.

@ Government of India, Ministry of Welfare ResolutionNo. 12011/96/94-BCC dated 9th March, 1996 published in theGazette of India Extraordinary Part-I, Section-1, No. 60 dated11th March,1996.

@ Government of India, Ministry of Welfare ResolutionNo. 12011/44/96-BCC dated 6th December, 1996 published inthe Gazette of India Extraordinary Part-I, Section-1, No. 210dated 11th December,1996.

@ Government of India, Ministry of Welfare ResolutionNo. 12011/99/94-BCC dated 11th December, 1997 published inthe Gazette of India Extraordinary Part-I, Section-1, No. 236dated 12th December,1997.

@ Government of India, Ministry of Welfare ResolutionNo. 12011/13/97-BCC dated 3rd December, 1997 published inthe Gazette of India Extraordinary Part-I, Section-1, No. 239dated 17th December,1997.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/68/98-BCC dated the 27thOctober, 1999 published in the Gazette of India ExtraordinaryPart-I, Section-1, No. 241 dated the 27th October,1999.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/88/98-BCC dated 6thDecember, 1999 published in the Gazette of India ExtraordinaryPart-I, Section-1, No. 270 dated 6th December,1999.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/36/99-BCC dated 4th April,2000 published in the Gazette of India Extraordinary Part-I,Section-1, No. 71 dated 4th April, 2000.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/44/99-BCC dated the 21stSeptember, 2000 published in the Gazette of India ExtraordinaryPart-I, Section-1, No. 210 dated the 21st September, 2000.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12015/9/2000-BCC dated 6thSeptember, 2001 published in the Gazette of India ExtraordinaryPart-I, Section-1, No. 246 dated 6th September, 2001.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/1/2001-BCC dated 19thJune, 2003 published in the Gazette of India ExtraordinaryPart-I, Section, 1 No. 151 dated 20th June, 2003.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/4/2002-BCC dated 13thJanuary, 2004 published in the Gazette of India Extraordinary,Part-I Section-1, No. 9 dated 13th January, 2004.

@ Government of India, Ministry of Social Justice andEmpowerment Resolution No. 12011/14/2004-BCC dated 12thMarch, 2007 published in the Gazette of India Extraordinary,Part-I, Section-1, No. 67 dated 12th March, 2007.

Shri/Shrimati/Kumari*................................and/or*his/her* family ordinarily reside(s) in village/town*................................ of ...................... District/Division* of the State/ UnionTerritory* of .............................

This is also to certify that he/she* does not belong tothe persons/sections* (Creamy Layer) mentioned in column 3of the Schedule to the Government of India, Department ofPersonnel & Training O.M. No. 36012/22/93-Estt(SCT) dated8-9-1993 O.M. No. 36033/3/2004-Estt.(Res.) dated 9th March,2004 and O.M. No. 36033/3/2004-Estt.(Res.) dated 14th October,2008.

Signature................................

**Designation............................

(with seal of Office)State/Union Territory

Place....................................................

Date.....................................................

*Please delete the words which are not applicable.@ Strike out whichever is not applicable.

NOTE : The term ‘‘ordinarily reside(s)’’ used here will havethe same meaning as in Section 20 of theRepresentation of the People Act, 1950.

** Authorities empowered to issue Other BackwardClasses certificates will be the same as thoseempowered to issue Scheduled Caste/ScheduledTribe certificates.

5

fVIi.kh 1fVIi.kh 1fVIi.kh 1fVIi.kh 1fVIi.kh 1%&vU; fiNM+h Jsf.k;ksa dk gksus dk nkok djus okysmEehnokjksa dks ;g uksV djuk pkfg, fd muds izek.ki=k esa nh xbZ mudh tkfr dk uke (orZuh lfgr) Bhdogh gksuk pkfg, tSlk dsUnzh; ljdkj }kjk le;&le;ij vf/lwfpr lwfp;ksa esa izdkf'kr fd;k x;k gSA ftlizek.k i=k esa tkfr ds uke esa fdlh izdkj dh fHkUurkg k s x h ] ml s vLohdkj dj fn; k tk,x k A

fVIi.kh 2fVIi.kh 2fVIi.kh 2fVIi.kh 2fVIi.kh 2%&mEehnokj ds vU; fiNM+h Js.kh ds gksus ds nkos dk fu/kZj.kml jkT; (;k ml jkT; ds fdlh Hkkx) ds vk/kj

ij fd;k tk,xk ftlls mlds firk ewyr% lEc¼ gSaAvr% og mEehnokj tks ,d jkT; (;k jkT; ds fdlhHkkx) ls vU; jkT; (;k jkT; ds fdlh Hkkx) esa izoztudj pqdk gS mls vU; fiNM+h Js.kh dk og izek.k i=kizLrqr djuk pkfg, tks mls mlds firk dks ml jkT;ftlesa og (firk) ewyr% lEc¼ gS ls izkIr vU; fiNM+hJs.kh ds izek.k i=k ds vk/kj ij tkjh fd;k x;k gksA

fVIi.kh 3fVIi.kh 3fVIi.kh 3fVIi.kh 3fVIi.kh 3%&vk;ksx lkekU;r% mEehnokj }kjk igys gh bl ijh{kkds vius ljyhd`r vkosnu i=k esa n'kkZ;h tkrh; fLFkfres a fdlh Hkh ifjorZu dh vuqefr ugha nsxkA

6

opuopuopuopuopueSa -------------------------------------------- iq=k@iq=kh Jh------------------------

---- xkao@dLck@'kgj ------------------- ftyk --------------------- jkT; ------------------ dk fuoklh gwwWaA eSa ,rn}kjk ?kks"k.kk djrk gwWa fd esSa -------------------------- leqnk; dk gwWa ftls dkfeZd ,oa izf'k{k.k foHkkx dsfnukad 8&9&1993 ds dk- Kk- la- 36012@22@93 LFkk- (,l- lh-Vh-)] esa fufgr vkns'kksa ds vuqlkj ukSdfj;ksa esa vkj{k.k ds fy, Hkkjrljdkj }kjk fiNMh tkfr ds :i esa ekU;rk nh x;h gSA eSa ;g Hkh?kks"k.kk djrk gwWa fd eSa fnukad 8-9-1993 (le;&le; ij la'kksf/r) ds mi;qZDr dk;kZy; Kkiu dh vuqlwph ds dkye 3 esamfYyf[kr O;fDr;ksa@oxksZ (Øhehys;j) ls laca/ ugha gwWaA

gLrk{kj --------------------------- mEehnokj dk uke ------------------------

vuqdzekad -------------------------

([k&A) ([k&A) ([k&A) ([k&A) ([k&A) Hkkjr ljdkj ds v/hu inksa ij fu;qfDr ds fy, vkosnuHkkjr ljdkj ds v/hu inksa ij fu;qfDr ds fy, vkosnuHkkjr ljdkj ds v/hu inksa ij fu;qfDr ds fy, vkosnuHkkjr ljdkj ds v/hu inksa ij fu;qfDr ds fy, vkosnuHkkjr ljdkj ds v/hu inksa ij fu;qfDr ds fy, vkosnudjus okys vU; ifNM+s oxksZa ds mEehnokjksa }kjk foLrr vkosnudjus okys vU; ifNM+s oxksZa ds mEehnokjksa }kjk foLrr vkosnudjus okys vU; ifNM+s oxksZa ds mEehnokjksa }kjk foLrr vkosnudjus okys vU; ifNM+s oxksZa ds mEehnokjksa }kjk foLrr vkosnudjus okys vU; ifNM+s oxksZa ds mEehnokjksa }kjk foLrr vkosnuizi=k ds lkFk ifjf'k"V&1 esa fn, x, opu dk izk:iizi=k ds lkFk ifjf'k"V&1 esa fn, x, opu dk izk:iizi=k ds lkFk ifjf'k"V&1 esa fn, x, opu dk izk:iizi=k ds lkFk ifjf'k"V&1 esa fn, x, opu dk izk:iizi=k ds lkFk ifjf'k"V&1 esa fn, x, opu dk izk:iAAAAA

Note 1 : Candidates claiming to belong to OBCs shouldnote that the name of their caste (including its spellings) asindicated in their certificates, should be exactly the same aspublished in the lists notified by the Central Government fromtime to time. A certificate containing any variation in the castename will not be accepted.

Note 2 : The OBC claim of a candidate will be determinedin relation to the State (or part of the State) to which his/her

father originally belongs. A candidate who has migrated fromone State (or part of the State) to another should, therefore,produce an OBC certificate which should have been issued tohim/her based on his/her father’s OBC certificate from theState to which he (father) originally belongs.

Note 3 : No change in the community status alreadyindicated by a candidate in his/her simplified application formfor this examination will ordinarily be allowed by theCommission.

6

(B-1) The format of undertaking to be furnished alongwith the DAF by Other Backward Class candidates applyingfor appointment to posts under the Government of India.

UNDERTAKING

I ………………………………. son/daughter ofShri …………………………… resident of Village/ Town/City ……………… District ………………. State/UT……………………… hereby declare that I belong to the………………………. Community which is recognized asa backward class by the Government of India for the purposeof reservation in services as per orders contained inDepartment of Personnel & Training Office MemorandumNo.36012/22/93-Estt(SCT) dated 8.9.1993. It is alsodeclared that I do not belong to persons/sections (CreamyLayer) mentioned in Column 3 of the Schedule to the abovereferred Office Memorandum, dated 8.9.1993 as ammendedfrom time to time.

Signature…………………………Name of the Candidate…………………………

Roll No…………………………

j{kk lsok ds nkSjku fodykax gq, mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZj{kk lsok ds nkSjku fodykax gq, mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZj{kk lsok ds nkSjku fodykax gq, mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZj{kk lsok ds nkSjku fodykax gq, mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZj{kk lsok ds nkSjku fodykax gq, mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZ

izekf.kr fd;k tkrk gS fd la- ------------------------------------------------------------------------------------------- jSad -------------------------------------------------

uke -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

;wfuV --------------------------------------------------------------------------ds j{kk lsokvksa esa dk;Z djrs gq, fons'kh 'k=kq&ns'k ds lkFk la?k"kZ esa@v'kkafrxzLr {ks=k·

esa iQkSth dk;Zokgh ds nkSjku fodykax gq, vkSj ml fodykaxrk ds ifj.kkeLo:Ik fueqZDr gq,A

gLRkk{kj ---------------------------------------------------------------------

inuke ---------------------------------------------------------------------

fnukad --------------------------------------------------------------------

·tks 'kCn ykxw u gks mls d`Ik;k dkV nsa-

ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&II

7

APPENDIX-II

THE FORM OF CERTIFICATE TO BE PRODUCED BY THE CANDIDATE DISABLEDWHILE IN THE DEFENCE SERVICES :—

Certified that No. ....................................................... Rank ......................................................

Name ...................................................................................................................................................................

of Unit ................................................................................. was disabled while in the Defence Service

in operations during hostilities with a foreign country/in a disturbed area* and was released as a

result of such disability.

Signature......................................

Designation.................................

Date.............................................

*Strike out whichever is not applicable.

7

8

ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&III

(d) fueqZDr@lsok fuo`(d) fueqZDr@lsok fuo`(d) fueqZDr@lsok fuo`(d) fueqZDr@lsok fuo`(d) fueqZDr@lsok fuo`ÙkÙkÙkÙkÙk dkfeZdks a ds fy, ykxw izek.k i=k dkfeZdks a ds fy, ykxw izek.k i=k dkfeZdks a ds fy, ykxw izek.k i=k dkfeZdks a ds fy, ykxw izek.k i=k dkfeZdks a ds fy, ykxw izek.k i=kdk iQkedk iQkedk iQkedk iQkedk iQkeZ

Izkekf.kr fd;k tkrk gS fd la- ----------------jSad ---------------uke ---------------------------------------------------------------------------------------------ftudh tUe frfFk ------------------------------- gS ------------ ls ------------rd lsuk@ukS lsuk@ ok;q lsuk esa lsok dh gS vkSj og fuEufyf[kr esa ls,d 'krZ iwjh djsa%&

(d) mUgksaus ikap ;k mlls vf/d o"kZ dh lSU; lsok dh gksvkSj lqiqnZ dk;Z dh lekfIr ij fjgk gq, gksa vU;Fkkdnkpkj ;k dk;Z vdq'kyrk ds dkj.k c[kkZLr u gq, gksaA

([k) os lSU; lsok ds dkj.k gqbZ 'kkjhfjd fodykaxrk vFkokv{kerk ds dkj.k ------------------------------- dks dk;ZeqDr gq,A

LFkku %fnukad%

l{ke izkf/dkjh dk uke vkSj inukeeksgj

([k)([k)([k)([k)([k) lsokjr dkfeZdks a ds fy, izek.k i=k dk iQkeZ (mulsokjr dkfeZdks a ds fy, izek.k i=k dk iQkeZ (mulsokjr dkfeZdks a ds fy, izek.k i=k dk iQkeZ (mulsokjr dkfeZdks a ds fy, izek.k i=k dk iQkeZ (mulsokjr dkfeZdks a ds fy, izek.k i=k dk iQkeZ (mulsokjr dkfeZdks a ij ykxw ftUgsa ,d o"kZ ds Hkhrj dk;ZeqDrlsokjr dkfeZdks a ij ykxw ftUgsa ,d o"kZ ds Hkhrj dk;ZeqDrlsokjr dkfeZdks a ij ykxw ftUgsa ,d o"kZ ds Hkhrj dk;ZeqDrlsokjr dkfeZdks a ij ykxw ftUgsa ,d o"kZ ds Hkhrj dk;ZeqDrlsokjr dkfeZdks a ij ykxw ftUgsa ,d o"kZ ds Hkhrj dk;ZeqDrfd;k tkuk gS)Afd;k tkuk gS)Afd;k tkuk gS)Afd;k tkuk gS)Afd;k tkuk gS)A

eSa ,rn~ }kjk izekf.kr djrk gwWa fd esjs ikl miyC/ lwpukds vuqlkj la- --------------------- jSad ---------------------- uke ---------------------------------------- fnukad --------------------------- ls lsuk@ukSlsuk@ok;q lsukesa lsokjr gSa vkSj os fnukad ------------------------- dks l'kL=k lsukvksa esavius fofu;kstu dh fofufnZ"V vof/ iwjh djus okys gSaALFkku %fnukad %

deku vf/dkjh ds gLRkk{kjdk;kZy; dh eksgj

mDr ^[k** izek.k i=k nsus okys mEehnokjksa dks fuEufyf[kropu nsuk gksxk%&

mEehnokjks a }kjk fn;k tkus okyk opumEehnokjks a }kjk fn;k tkus okyk opumEehnokjks a }kjk fn;k tkus okyk opumEehnokjks a }kjk fn;k tkus okyk opumEehnokjks a }kjk fn;k tkus okyk opueq>s Kkr gS fd ;fn bl vkosnu i=k ls lacaf/r

HkrhZ@ijh{kk ds vk/kj ij p;u gks tkrk gS rks ;g fu;qDr esj s}kjk fu;qDr izkf/dkjh dks bl vk'k; dk lark s"ktud fyf[krizek.k izLrqr djus ds v/hu gksxh fd es a l'kL=k lsukvks a lsfof/or :Ik ls fueq ZDr@lsokfuo`r@dk;ZeqDr gks x;k gw W a vkSj;g fd le;&le; ij ;Fkkla'kk sf/r HkwriwoZ lSfud (dsUnzh;

flfoy lsokvksa rFkk inksa esa iqufuZ;kstu) fu;ekoyh] 1979 dh 'krksZads vuqlkj HkwriwoZ lSfudksa dks xzká ykHkksa dk gdnkj gwWaALFkku %fnukad %

mEehnokj ds gLRkk{kj(x)(x)(x)(x)(x) bZ-lh-vks-@,l-,l-lh-vks- ftUgks aus igys gh lsok dhbZ-lh-vks-@,l-,l-lh-vks- ftUgks aus igys gh lsok dhbZ-lh-vks-@,l-,l-lh-vks- ftUgks aus igys gh lsok dhbZ-lh-vks-@,l-,l-lh-vks- ftUgks aus igys gh lsok dhbZ-lh-vks-@,l-,l-lh-vks- ftUgks aus igys gh lsok dhizkjfEHkd fu;fer vof/ iwjh dj yh gS vkSj fu;qfDr dhizkjfEHkd fu;fer vof/ iwjh dj yh gS vkSj fu;qfDr dhizkjfEHkd fu;fer vof/ iwjh dj yh gS vkSj fu;qfDr dhizkjfEHkd fu;fer vof/ iwjh dj yh gS vkSj fu;qfDr dhizkjfEHkd fu;fer vof/ iwjh dj yh gS vkSj fu;qfDr dhc<+kbZ xbZ vof/ ij gS ds fy, izek.k i=k dk iQkeZAc<+kbZ xbZ vof/ ij gS ds fy, izek.k i=k dk iQkeZAc<+kbZ xbZ vof/ ij gS ds fy, izek.k i=k dk iQkeZAc<+kbZ xbZ vof/ ij gS ds fy, izek.k i=k dk iQkeZAc<+kbZ xbZ vof/ ij gS ds fy, izek.k i=k dk iQkeZA

;g Izkekf.kr fd;k tkrk gS fd la- --------------------------------jSad ----------------------------- uke ------------------------------------------------------ftudh tUe frfFk ---------------------------- gS --------------------------------- lslsuk@ukS lsuk@ok;q lsuk esa lsok dj jgs gSaA

2- mUgksaus igys gh vkjfEHkd dk;Zdky dh ikWap o"kZ dhlsok --------------------------- dks iwjh dj yh gS vkSj vc os ---------------rd c<+k, x;s dk;Zdky ij gSA

3- mUgsa flfoy jkstxkj esa vkosnu i=k nsus ds fy, dksbZvkifÙk ugha gS rFkk mUgsa flfoy jkstxkj feyus ij rhu ekg ds uksfVlij dk;ZeqDr fd;k tk,xkA

l{ke izkf/dkjh dk uke vkSj inukeeksgj

LFkku%fnukad%izkf/dkjh tks izek.ki=k tkjh djus ds fy, l{ke gSa fuEu izdkj gSa%&

(d) bZ-lh-vks-@,l-,l-lh-vks- lfgr deh'kaM vf/dkfj;ksa dsekeys esa%&

Fky lsuk&fefyVjh lfpo dh 'kk[kk] Fky lsuk eq[;ky;]ubZ fnYyhA

ukS lsuk &dkfeZd lsok funs'kky;] ukS lsuk eq[;ky;] ubZfnYyhA

ok;q lsuk& dkfeZd lsok funs'kky; (vf/dkjh)] ok;qlsuk eq[;ky;] ubZ fnYyhA

([k) ts-lh-vks@vks-vkj- rFkk ukS lsuk vkSj ok;q lsuk dsled{k ds ekeys esa%&

lsuk& fofHkUu jsthesUVy vfHkys[k dk;kZy;ksa }kjkA

ukS lsuk&ch-,-ch-,l-] eqEcbZA

ok;q lsuk&ok;q lsuk vfHkys[k ,u-bZ-vkj-MCY;w-] ubZ fnYYkhA

APPENDIX-III

(A) FORM OF CERTIFICATE APPLICABLE FORRELEASED/RETIRED PERSONNEL.

It is certified that No..................... Rank.....................Name..........................................whose date of birth is.....................has rendered service from..................... to..................... in Army/Navy/Air Force and he fulfils the following conditions :—

(a) Has rendered five or more years military serviceand has been released on completion of assignmentotherwise than by way of dismissal or dischargeon account of misconduct or inefficiency.

(b) Has been released on account of physical disabilityattributable to military service or on invalidmenton.....................

Station : ..........................

Date : ...........................

Signature and Designation of theCompetent Authority

SEAL

(B) FORM OF CERTIFICATE FOR SERVINGPERSONNEL

(Applicable for serving personnel who are due to bereleased within one year).

I hereby certify that according to the informationavailable with me No.......................... Rank.........................Name.......................................... is serving in the Army/Navy/Air Force from.......................................... and is due to completethe specified term of his engagement with the Armed Forceson the date.....................

Place :

Date :

Signature of Commanding OfficerOffice Seal

Candidate furnishing certificate B as above will have togive the following undertaking :—

UNDERTAKING TO BE GIVEN BY THE CANDIDATE :

I understand that if selected on the basis of therecruitment/Examination to which this application relates, myappointment will be subject to my producing documentaryevidence to the satisfaction of the appointing authority that Ihave been duly released/retired/discharged from the Armed

Forces and that I am entitled to the benefits admissible to Ex-servicemen in terms of the Ex-Servicemen (Re-employmentin Central Civil Service and Posts) Rules, 1979, as amendedfrom time to time.

Signature of Candidate

Place :

Date :

(C) FORM OF CERTIFICATE APPLICABLEFOR SERVING ECOs/SSCOs WHO HAVE ALREADYCOMPLETED THEIR INITIAL ASSIGNMENT ANDARE ON EXTENDED ASSIGNMENT.

It is certified that No...................... Rank.....................Name.......................................... whose date of birth is.....................is serving in the Army/Navy/Air Force from......................

2. He has already completed his initial assignment offive years on———————and is on extended assignmenttill———————.

3. There is no objection to his applying for civilemployment and he will be released on three months noticeon selection from the date of receipt of offer of appointment.

Station :

Date :

Name and Designation of theCompetent Authority

SEAL

Authorities who are competent to issue certificate areas follows :—

(a) In case of Commissioned Officers includingECOs/SSCOs.

Army—Military Secretary Branch, Army Hqrs.,New Delhi.

Navy—Directorate of Personnel, Naval Hqrs.,New Delhi.

Air Force—Directorate of Personnel Officers, AirHqrs., New Delhi.

(b) In case of JCOs/ORs and equivalent of the Navyand Air Force.

Army—By various Regional Record Offices.

Navy—BABS, Mumbai.

Air Force—Air Force Records NERW,New Delhi.

8

fu;e 5([k) ds rgr vk;q esa NwV pkgus okys mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZfu;e 5([k) ds rgr vk;q esa NwV pkgus okys mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZfu;e 5([k) ds rgr vk;q esa NwV pkgus okys mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZfu;e 5([k) ds rgr vk;q esa NwV pkgus okys mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZfu;e 5([k) ds rgr vk;q esa NwV pkgus okys mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZ

·(d) Jh@Jherh@dqekjh ---------------------------------------------------------------------------------- fnukad ls ----------------------- dk;kZy;@foHkkx esa------------------------------------------------------- ds LFkk;h in ij (ewy :Ik ls) dk;Zjr gSaA

·([k) Jh@Jherh@dqekjh ---------------------------------------------------------------------------------- fnukad ls ------------------------ dk;kZy;@foHkkx esa------------------------------------------------------ ds in ij dsUnzh; ljdkj ds v/hu fu;fer vk/kj ij vLFkk;h lsok esa yxkrkj dk;Z dj jgh@jgs gSaA

(x) ;g foHkkx@dk;kZy; fuEufyf[kr izkf/dkjh ds fu;a=k.kk/hu gS] tks bathfu;jh lsok ijh{kk] 2011 dh fu;ekoyh ds fu;e5([k) ds uhps dkye 1 esa fufnZ"V izkf/dkjh esa ls ,d gSA

(d`Ik;k ;gka lEc¼ izkf/dkjh dk uke fy[ksa)

gLRkk{kj ----------------------------------------------------------------inuke ------------------------------------------------------------------

ea=kky;@dk;kZy; ---------------------------------------------------

dk;kZy; dh eksgj

LFkku % -----------------------------------------

fnukad % -----------------------------------------

·tks 'kCn ykxw u gks mlssa dkV nsaA

ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&IV

9

THE FORM OF CERTIFICATE TO BE PRODUCED BY GOVERNMENT SERVANTS CLAIMING AGECONCESSION UNDER RULE 5(b)

Certified that:

*(a) Shri/Shrimati/Kum. ............................................................ holds substantively a permanent post of ................................in the Office/Department of ........................................with effect from ...................................................

*(b) Shri/Smt./Kum. ....................................... has been continuously in temporary service on a regular basis underthe Central Government in the post of .......................................................in the ....................................................witheffect from .................................

(c) This Deptt./Office is under the control of the following authority, which is one of the authorities specified inColumn I below Rule 5 (b) of the Rules of the Engineering Services Examination, 2011.

(Please indicate here the name of the concerned authority)

Signature..............................................................

Designation.........................................................

Ministry/Office.....................................................

Office Stamp

Place ........................

Date : ........................

APPENDIX-IV

9

10

ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&ifjf'k"V&V

laLFkku@vLirky dk uke o irklaLFkku@vLirky dk uke o irklaLFkku@vLirky dk uke o irklaLFkku@vLirky dk uke o irklaLFkku@vLirky dk uke o irk

izek.ki=k la- ------------------------------------ fnukad ----------------------------

v{kerk izek.ki=kv{kerk izek.ki=kv{kerk izek.ki=kv{kerk izek.ki=kv{kerk izek.ki=k

fpfdRlk cksMZ dsv?;{k }kjk fof/or~ vuqizekf.krv{kerk n'kkZus okykmEehnokj dk gkydk iQksVksxzkiQ

;g izekf.kr fd;k tkrk gS fd Jh@Jhefr@dq- ----------------------------------------------------------------iq=k@iRuh@iq=kh Jh ------------------------------- vk;q--------------------------------- fyax --------------------- igpku fpUg (fpUgksa)----------------------- fuEufyf[kr Js.kh dh v{kerk LFkk;h :Ik ls gSA

d-d-d-d-d- pyus esa vleFkZ ;k izefLr"dh; i{kk?kkrpyus esa vleFkZ ;k izefLr"dh; i{kk?kkrpyus esa vleFkZ ;k izefLr"dh; i{kk?kkrpyus esa vleFkZ ;k izefLr"dh; i{kk?kkrpyus esa vleFkZ ;k izefLr"dh; i{kk?kkr(i) ch-,y-(BL)&nksuksa iSj [kjkc@izHkkfor ijUrq Hkqtk,a ughaA(ii) ch-,-(BA)&nksuksa Hkqtk,a izHkkfor (d) {kh.k igqap

([k) detksj idM+(iii) ch-,y-,-(BLA)&nksuksa iSj rFkk nksuksa Hkqtk,a izHkkfor(iv) vk-s,y-(OL)&,d iSj izHkkfor (nk;ka ;k ck;ka)

(d) {kh.k igqap([k) detksj idM+(x)(xfrfoHkze@,VSfDld)

(v) vks-,-(OA)&,d Hkqtk izHkkfor(d) {kh.k igqap([k) detksj idM+(x)(xfrfoHkze@,VSfDld)

(vi) ch-,p-(BH)&l[r ihB ;k dwYgs (cSB ;k >qd ugha ldrs) (vii) ,e-MCY;w-(MW)&ekalis'kh; nqcZyrk rFkk lhfer 'kkjhfjd

lgu'kfDr

[k-[k-[k-[k-[k- us=kghurk ;k de ({kh.k) n`f"Vus=kghurk ;k de ({kh.k) n`f"Vus=kghurk ;k de ({kh.k) n`f"Vus=kghurk ;k de ({kh.k) n`f"Vus=kghurk ;k de ({kh.k) n`f"V(i) ch (B) & us=kghu(ii)ih-ch- (PB) vkaf'kd :Ik ls us=kghu

·tks Js.kh ykxw u gks mlssa dkV nsaA

x-x-x-x-x- Jo.kckf/rJo.kckf/rJo.kckf/rJo.kckf/rJo.kckf/r(i) Mh (D) & cf/j(ii) ih-Mh- (PD) vkaf'kd :Ik ls cf/j

(tks Js.kh ykxw u gks mlssa dkV nsa)2- ;g fLFkfr izxfr'khy@vizxfr'khy@lq/kj dh laHkkouk@lq/kj

dh laHkkouk ugha gSA ------------- o"kZ ------------- eghus dh vof/ dsckn bl ekeys dh iquewZY;kadu dh vuq'ka'kk dh xbZ gS@vuq'ka'kk ughadh xbZ gSA

3- muds@mudh ekeys esa v{kerk dh izfr'krrk ---- izfr'kr gSA

4- Jh@Jherh@dqekjh ------------------------------------------------- vius nkf;Rods fuoZgu ds fy, fuEufyf[kr 'kkjhfjd vis{kk,a iwjh djrs@djrh gSa%&

(i) ,iQ (F)&vaxqfy;ksa dks O;ofLFkr djds fd, tkus okys dk;Zgk¡@ugha

(ii) ih-ih- (PP)&[khapdj rFkk /dsydjfd, tkus okys dk;Z gk¡@ugha

(iii) ,y (L)&mBk dj fd, tkus okys dk;Zgk¡@ugha

(iv) ds-lh- (KC)&?kqVus ds cy ij cSBdj ;k Øsfpax }kjk fd, tkus okys dk;Z gk¡@ugha

(v) ch (B)&>qddj fd, tkus okys dk;Zgk¡Wa@ugha

(vi) ,l (S)&cSBdj fd, tkus okys dk;Zgk¡@ugha

(vii) ,l-Vh- (ST)&[kMs+ jg dj fd, tkus okys dk;Zgk¡@ugha

(viii) MCY;w (W)&py dj fd, tkus okys dk;Zgk¡@ugha

(ix) ,l-bZ- (SE)&ns[k dj fd, tkus okys dk;Zgk¡@ugha

(x) ,p (H)&lqudj@cksy dj fd, tkus okys dk;Zgk¡@ugha

(xi) vkj-MCY;w (RW)&i<+dj ;k fy[kdj fd, gk¡Wa@ughtkus okys dk;Z

a

(MkW- ------------------) (MkW- ------------------) (MkW- ------------------)

lnL; lnL; v?;{k fpfdRlk cksMZ fpfdRlk cksMZ fpfdRlk cksMZ

vLirky ds fpfdRlkv/h{kd@lh-,e-vks-@

izeq[k }kjk izfrgLRkk{kfjr(eqgj lfgr)

APPENDIX-V

Name & Address of the Institute/Hospital

Certificate No. ...................................Date : ..........................

DISABILITY CERTIFICATE

Recent Photograph ofthe candidate showingthe disability dulyattested by theChairperson of the

Medical Board.

This is certified that Shri/Smt./Kum. ...............................son/wife/daughter of Shri ......................................... age ..........sex ............ identification mark(s) ........................ is sufferingfrom 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 physicalendurance.

B. Blindness or Low Vision :

(i) B—Blind

(ii) PB—Partially blind

* Strike out whichever is not applicable.

C. Hearing impairment :

(i) D—Deaf

(ii) PD—Partially deaf

(Delete the category whichever is not applicable)

2. This condition progressive/non-progressive/likely toimprove/not likely to improve. Re-assessment of this case isnot recommended/is recommended after a period of ................years ............................... months.*

3. Percentage of disability in his/her case is .......................per cent.

4. Shri/Smt./Kum. ...................................... meets thefollowing physical requirements for discharge of his/herduties :—

(i) F—Can perform work by manipulatingwith fingers. Yes/No

(ii) PP—Can perform work by pulling andpushing. Yes/No

(iii) L—Can perform work by lifting. Yes/No

(iv) KC—Can perform work by kneeling andcrouching. Yes/No

(v) B—Can perform work by bending. Yes/No

(vi) S—Can perform work by sitting. Yes/No

(vii) ST—Can perform work by standing. Yes/No

(viii) W—Can perform work by walking. Yes/No

(ix) SE—Can perform work by seeing. Yes/No

(x) H—Can perform work by hearing/speaking. Yes/No

(xi) RW—Can perform work by reading andwriting. Yes/No

(Dr. .......................) (Dr. .......................) (Dr. .......................)

Member Member ChairmanMedical Board Medical Board Medical Board

Countersigned by the MedicalSuperintendent/CMO/Head of

Hospital (With seal)

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ANNEXURE

GUIDELINES

CODE NUMBERS FOR FILLING UP THE APPLICATION FORM

Codes to be given for filling up different columns in the application form are mentioned below :—

Column 12 : CITIZENSHIP

Code Description

01 . a citizen of India

02 . a subject of Nepal

03 . a subject of Bhutan

04 . a Tibetan refugee who came over to India before the Ist January, 1962 with the intention of permanently settlingin India.

05 . a person of Indian origin who has migrated from Pakistan, Burma, Sri Lanka, East African countries of Kenya,Uganda, the United Republic of Tanzania, Zambia, Malawi, Zaire or Ethiopia or Vietnam with the intention ofpermanently settling in India.

Column 13 : STATE OF DOMICILE

Code State or Union Territory Code State or Union Territory

01 Andhra Pradesh 19 Nagaland02 Arunachal Pradesh 20 Orissa03 Assam 21 Punjab04 Bihar 22 Rajasthan05 Chhattisgarh 23 Sikkim06 Goa 24 Tamil Nadu07 Gujarat 25 Tripura08 Haryana 26 Uttrakhand09 Himachal Pradesh 27 Uttar Pradesh10 Jammu & Kashmir 28 West Bengal11 Jharkhand 29 Andaman & Nicobar Islands12 Karnataka 30 Chandigarh13 Kerala 31 Dadra and Nagar Haveli14 Madhya Pradesh 32 Daman & Diu15 Maharashtra 33 Delhi16 Manipur 34 Lakshadweep17 Meghalaya 35 Puducherry18 Mizoram

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Wrong Right

NOTE : Candidate should be twice sure of giving the right code. Whenever one or more boxes like have beenprovided for the answer, care has to be exercised that not more than one numeral is entered in one box. If the code requires twoor more digits then as many boxes have been provided. Further, whenever a code reads like 01 or 02 i.e. there is a 0 on the left,one should take care to enter the code with the 0. The code should not be entered without 0 as illustrated below :—

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