CAzs-6

(.e/.A.P jz CsyUU iv)

-r
(Ai 3J (2)(3) r)
Cav ew v Cav qPlUU jz CsyUU q it vU .
it v

________________gdz / PAzqv zz * _____________fAi / sUz

_____________U / lt * Aiiz / w ______________JAg U / Uz
/ w _______________Eg Cav ew / Cav qPl * JAz i
iqVg ew / qPn
U * jgvgAz itPjVz.

Azs (Cav ewU) Dz, 1950.

Azs (Cav qPlU) Dz, 1950.
Azs (Cav ew) (PAzqv zU) Dz, 1950.
Azs (Cav qPlU) (PAzqv zU) Dz, 1951.
(Cav ew v Cav qPl U n (iq) Dz 1956,
A gd, g gZ CAi, 1960, Ae gd g gZ
CAi, 1966, iZ z gd CAi 1970 v F
zU (g gZ CAi, 1971g P wzrAiizAv).
Azs (d v Pg) Cav ewU Dz, 1956.
Cav ew v Cav qPl U (wzr) CAi, 1976 g
P
wzrAiizAv Azs (CAqi v Pg U) Cav
qPlU Dz, 1959.
Azs (zzg v Ug ) Cav ewU Dz, 1962.
Azs (ArZj) Cav ewU Dz, 1964.
Azs (Cav qPlU) (Gvg z), 1967.
Azs (U, z v ) Cav ew / qPlU Dz,
1988.
Azs (UAq) Cav qPlU Dz.

2. / w/ Pij * ______________________ v / Cx C */C* PlA

_______ gd /PAzqv zz ________________ f / sUz * __________________
U / lAz i (U).

:______________________
vg:_________________
: z:
AP: PbjAi jAU

Page|72

 gd / PAzqv z *
* CAiUg zU zAil lr / qz Q.

Z: E GAiVz i U JA zAi e wzs CAi, 1950 g 20

Pgtzg Cx Agvz.

sgv Pgz v AS: 12028/2/78 J n-1 UAvAiz CgV, CAx it vU

q PVgzPV, sgv Pgz (A v Dqv zsgu ES) v AS:13-2-74 EJ
n((J n) AP 5 DU 1975 g z PjAi, gwU AAzsl Dzz
CZAi grz Aiz it vP V Cf z QAi, v SAiA
Az P jzggVgvPz. Cz jwAi, MAz vQ g PjAi EAz vQU
jz QUU AAzsl it v q P PjAiiU.

Page|73

 (U-1 P jz CsyUU iv)

E
(Ai 3J (2) (3) r)
Azz UUU jz CsyUU q it v

______________________ U / lt /Ugz Aiiz / w________________ Eg

U / U / w /wAiiz / w __________________Eg Azz UU (U)
_______________ ewAi _____________________GewU jgvgAz itPjVz.

vgg
AP: _________ vP
PZjAi g.

Page|74

 (U-2J, 2, 3J, 3 U jz CsyUU iv)

Js
(Ai 3J (2) (3) r)
Azz UUU(2J, 2, 3J, 3) jz CsyUU q DzAi v ew it v
_____________________g Vg / w ____________________ Eg
U/U/w/wAiiz, / w / Pij_______________________Eg
v/Pg/w / wAi, Pj DzU AS: AP 148 J 2015 AP: 04-06-2015
g rz gz (Q Aig) Ai gAz:

CsyAiiU Cx Dv / DPAi vAz v / PgU / w / wAiiU, Pgz

Ai 1 zeAi Cx 2 zeAi CPjAiiVAz:
Cx
dP Ai Gzz vviz zAi AgAz.
Cx
SV AidPg P PU 2 zeAi CPjAi AQAv ( v t g.22,800 -
43,200 gAP Av) Prz A qAi PgVAz;
Cx
Cfzgg v Dv / DPAi vAz v / Pg / w / wAi P DzAi
g. 6.00 PUVAv jggz.
Cx
Dv / DPAi vAzv/Pg / w / wAi s zsgu PAi 1961 g CrAi
Urz 10 Aim P sVAv Z P s Cx Am Ai sU
AAzAv 20 JPgVAv Z s AgAz itPjz.

/ w / Pij ____________ Eg _____________ UU ________ Uz g

___________ewU jgvgAz v F PlAz P DzAi g._______/- JAz
itPjVz.

F zrPgt v
Lz z CU ZAigvz.

: vgg
AP: _________ vP
PZjAi g.

Z:
1. Pgz Dz AS: AP 148 J 2015, AP:04-06-2015 gAv Azz UU
U-2J, 2, 3J v 3 wUU CAv PzgP Urg CsyAi
v Cg vAz-v, Pg P Ml DzAi wAi (Gross Annual Income)
g. 4.50 PUAz g. 6.00 PUU aVz. DzzjAz, w itv
q CPv CPjAi AP: 04-06-2015 g Pj Dzz CAU gV
RavrPAq Avg qvPz.
2. F z Pj Dzz CAU UzlPAq zj wU
P iq CsyU CzgAv ew/w it vU
ir az.

Page|75

 -1
dg jm CsyU gP jAz, zrPj Ut wAi Pg Pz
it v
(dg jm CsyU sw iqPz )
EjU,
vgg
__________ vP
__________ f.
ig,
/ w _______________ JAg U / U / w /w ___________
Dz gz (Creamy Layer) gAz g PwAi Ut Csy
wAi qAizPV it v qAi v F PPAq iwU
MzVv Pgv.
1. CsyAi g v GzU :
2. CsyAi Av U :
vP :
f :
3. CsyAi nz AP Ai v nz :
1. CsyAi vAz/v/ Pg wAi /
wAi g v GzU :
(GzU Pj /Cg Pj /dP Gz /SV)
2. CsyAi v
(V z
3. CsyAi v
4. CsyAi Ptz AU irz U gU
xP
izsP
qs
5. CsyAi U CsyAi vAz/v/
Pg (vAz/v fAvzg) Eg
Ml P DzAi J UAz:
i) v t
ii) d g
iii) Evg U
6. DzAi vjU wzgg?
7. Av vjU wzgg?
8. igl vjU wzgg?
itPv Wu
F Az MzVz iw / guAi wgg nU vAz
zPV zrPjv v Wv.

: v zsAi,
AP :
(CsyAi )

Page|76

 MzVz iwU vVgvz JAz itPjv, F iwU CvAz

zqsl Cgzs ZguU zVgv.

vAz/v/Pg .
(vAz/v fAvzg)
(Aqw/UAq/Eg )
Ai Eg Qzgg :

CsyAi v vAz/v/Pg/w/w Eg U Eg Ai Ugwv.

Qzgg : 1)
2)
(t zAU)

j it v
1. /w __________________ JAg U/U/w/w /w / Pij
____________
JAg PlP gdz _______________ fAi sU ____________ U / lt /
Ugz i AiiVzgAz v Eg dg jm UP jzgVgvg.

1. / w / Pij ___________ Eg vAz / v / Pg Pj

Dz AS:J qr 251 J 94, AUg, AP: 31-01-1995 gAi
dg jm Uz gz (Creamy Layer) gAz
itPjVz.

: vgg
AP: _________ vP
PbjAi g.

Z-1: Ezg GAiVz i JA z 1950 g dv wzs PzAi

20 CZzz Cx Agvz.
Z 2: j it v q CPv CPjAi Pj Dz AS: Jqr 251
J 94, AUg, AP: 31-01-1995 gAi g (Creamy Layer) zg Ugw
UrVg CAU gV RavrPAq Avg it v qvPz.

Page|77

 Pj Dz AS DE 96 2003, AP 10-08-2005
-2
Ut Csy it v
/ w _________________________________gg U / U / w / w /
w/Pij____________ f ____________ vP ___________ Uz ____________
Vg Eg MAz vgUwAz ____________ vgUwAigU ____________ f
_______________ vP ________________ lt Ai AU ir ______________
qz jPAi GwtgVgvg. F Ai CsyAi AU irz CAi
PlPz gUU CAi, 1976 Cx PlP gsU CAi, 1964 g CrAi
rz MAz zq Ug z, t Ug z Cx jv Avzg zU
gvz zzv.

()
SzsAig,

gd
Pv Pt CPj

Page|78

 Pgz v AS: DE 44 2001 AP: 27-07-2001

-3
AidUAz vgz PlAz Csy
it v

/ w _______________ JAg U/U/w/w / w/Pij____________

f ____________ vP ___________ Uz ____________ Vg Eg : Eg
PlAzg CAvgVz F PPAq DAi ____________ AidUV ____________
E ___________ AiAz rPVz JAz F P itPjz:-

i) ** v v CAvgVz Cg P sAi Czsz;

ii) ** AidU z sAi Agz ; AidAz v ;
iii) ** v CAvgVz v P sAi Czsz Cx CzQAv Pr P
s;
iv) ** Evg Ez Pgtz AidAz vgzg.
vg
vP.
(** CAiU LlA iv it vz vPz.)

Page|79

 Pq izs AU it v

/ w _______________ gg U/U/w / w/Pij____________ f

____________ vP ___________ Uz ____________ Vg vgUwAz
____________ vgUwAigU ____________ PtP Az _______________ PtP
zgU ________________ Ai Pq izsz AU irgvgAz
itPjVz.

AP : ____________ SzsAig v AAi g.

: ____________

Z :- CsyU MAzQAv a U AU irz g vP Pq izs

AU it v P.

Page|80

 gd Pj / PAz Pj /Ai Pg Pgg MzVPz it v

/ w ______________________ gg gd / PAz Pg / Ai Pgz

_______________ (z) __________________________________ ESAi SAiA /
vvP zAi AP ____________________ jAz __________________________ ggU
Agg. F zU Eg Pw AiUr DAiAiiVz, zj zU Cf CjU
Cw qVz.
: ____________ Pw Pgz /-
AP : ____________ ESAi g v gAU

CERTIFICATE TO BE FURNISHED BY THE STATE/CENTRAL GOVT./ Local Authority

SERVANTS

Certified that Sri / Smt _____________________________________ holds a permanent /

temporary post under the State/Central Govt./Local Authority as
_____________________________(Designation) in the dept of ______________________ from
__________________________ having been appointed there-in under the rules of recruitment . He / She is
permitted to apply for the said post.

Place: Signature of appointing authority

Date: of the department / with name and seal.

Page|81

 PlP Pgz CPv e AS: DE 115 2005, AP: 19-11-2005

CERTIFICATE FOR THE PERSONS WITH DISABILITIES

This is to certify that Sri/Smt/Kum -----------------------------------------------------------------------

Son/wife/Daughter of Shri --------------------------------------Age ----------------------------old,
male/female, Registration No-------------------------------------------------is a case of ------------------
------------------------------------------------------------He/She is physically disabled/visual disabled
/speech & hearing disabled and has -------------------------------%--------------------------------------
percent ) permanent physical impairment /visual impairment speech & hearing impairment) in
relation to his/her-----------------------------------------------
Note:-
1. This condition is progressive / non progressive likely to improve / not likely to improve.
2. Re-assessment is not recommended / is recommended after a period of ----------------------
-months / years.
o Strike out which is not applicable
Recent Sd/- Sd/- Sd/-
Photograph showing Doctor Doctor Doctor
Disability affixed here) (Seal) (Seal) (Seal)

Countersigned by the
Medical Superintendent CMO/ Head of
Hospital (with seal)
Signature /Thumb impression
of the disabled person

Explanation :-
1) Blindness refers to a condition where a person suffers from any of the
following conditions namely:- (a) Total absence of sight; of (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.

Page|82

 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.

Page|83

 CAzs-J
Cv it v
CZz 371(e) gU)
(3)(3) Ai r)

it v q PlP dP GzU (zgz-PlP zP PwAi w)

AiU 2013)
/w__________________________________________gg _______________________________
gg U/AqwAiiVz, Eg PlP gdz____________________fAi _______________vQ
_____________________________________U/ltz Ai QAiiVzg.

:_______________ g_________________
AP:____________ CAm Pg
____________G sU
__________________f.

CAzs-r
U it v
CZz 371(e) gU)
4 (E) Ai r)

it vU rPUV PlP dP GzU (zgz-PlP zP PwAi w)

AiU 2013)
/w__________________________________________gg _______________________________
gg U/AqwAiiVz, Eg PlP gdz____________________fAi _______________vQ
_____________________________________U/lt v U / JAz v Pz
Wgvg.
Pzg z RzV jz v z 01-01-2013P AZ
Pz z iqVvAz vB jP irPArgv.

:_______________ g_________________
AP:____________ z _______________
Pbj ________________
ES _________________

Page|84