ARMY RECRUITEMENT OFFICE, GUNTUR CHEST NUMBER / Ku <O

PART-1 : UNDERTAKING BY THE CANDIDATE

1. I AM FULLY AWARE THAT RECRUITMENT IS A FREE SERVICE AND NO MONEY IS REQUIRED
TO BE PAID TO ANY PERSON OR AGENCY, IF AT ANY STAGE IT IS DISCOVERED THAT I HAVE
PAID ANY MONEY TO GET RECRUITED, I AM LIABLE TO BE DISQUALIFIED OR IN THE EVENT OF
SAME BEING DISCOVERED DURING MY TRAINING I AM LIABLE TO BE DISCHARGED FROM
SERVICE AND FACE CRIMINAL PROCEEDINGS. PHOTO OF
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q^"# _| XH =HH Hx, XH U[hH Hx H@^. <# U l <## Z=iH## _| CANDIDATE TO BE
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2. I UNDERSTAND THAT I AM PARTICIPATING IN SCREENING TEST FOR ARMY AT MY OWN TESTER JCO
RISK. I WILL NOT CLAIM ANY COMPENSATION FOR ANY INJURY/DEATH SUSTAINED BY ME
DURING THE SCREENING AND SELECTION PROCESS.
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3. I AM NOT / HAVE NOT BEEN A MEMBER OF ANY BANNED / POLITICAL ORGANIZATION AND HAVE NOT BEEN IN CUSTODY / JAIL
AND NO CRIMINAL OR JUDICIAL CASE WAS HELD AGAINST ME/PENDING AGAINST ME IN ANY COURT OF LAW IN INDIA/ABROAD, I
HAVE NEVER BEEN CONVICTED/TRIED FOR ANY OFFENCE UNDER THE LAW.
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4. I HAVE MY PARENTS CONSENT TO PARTICIPATE IN THE RALLY
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5. Particulars of Candidate

Name.......................................................................................................................................................................
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Son of.......................................................................................................................................................................
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Date of Birth......................................................................................................................................................................
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Educational Qualification.................................................................................................................................................
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Religion....................................................................................................................................................................
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Sub Caste.........................................................................................................................................................................
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Caste........................................................................................................................................................................
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Address: Door Number................................................................................................................................................
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Village......................................................................................................................................................................
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Post Office........................................................................................................................................................................

Police Station...................................................................................................................................................................
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Tehsil/Taluka....................................................................................................................................................................
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District......................................................................................................................................................................
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State.........................................................................................................................................................................
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PIN...........................................................................................................................................................................
< H_ Married / Un Married
6. Married Status :...................................................................Date of Marriage : (If Married)..............................................
=~* q=~= : =~* J~#^ / =~* H^ U `n# =~* J~#k : (h =~* J~#K)
Date : Left Thumb Impression : Signature of Candidate
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 PART-II : DOCUMENT SCREENING SLIP

1. CATEGORY SOL (TDN) 8TH/10TH PASS / SOL GD/ SOL TECH/ NA/VET)/SOL (CLK/SKT)
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2. EDUCATION SSLC HSC YES NO
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3. DATE OF BIRTH D D M M Y E A R YES NO
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4. NATIVITY CERT YES NO
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5. CASTE CERT YES NO
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6. CHARACTER CERT FROM VILL SARPANCH / POLICE YES NO
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7. CATEGORY FOR BONUS MARKS : (a) NCC A/B/C (b) SOWW / SOW / SOEX / SOX (c) SPORTSMAN
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8. ELIGIBLE TO APPEAR FOR PHYSICAL FITNESS TEST ON................FOR................. YES NO

CERTIFICATE FROM SCREENING NCO AND TESTER JCO

IT IS CERTIFIED THAT THE DOCUMENTS OF THE ABOVE MENTIONED CANDIDATE HAVE BEEN
THOROUGHLY SCREENED BY ME AND THE ABOVE MENTIONED CANDIDATE MEETS THE LAID DOWN QR FOR
THE TRADE AS MENTIONED ABOVE. CANDIDATE HAS SIGNED ABOVE / AFFIXED HIS THUMB IMPRESSION ON
THE SLIP IN MY PRESENCE.

DATE : 20 Stamp Signature of Screening NCO Stamp Signature of Tester JCO

CERTIFICATE FROM DC/SDM/TEHSILDAR/REVENUE OFFICER OR NOMINATED BY THE DISTRICT ADMINISTRATION

NATIVITY CERTIFICATE VERFICATION

This is certified that nativity certificate of the candidate has been verified and found correct. Verification report
has been endorsed on two photocopies of the Nativity certificate.

Date : (Signature and Seal Impression of the officer)

This is certified that Mark Sheets/Education Certificates of the candidate / date of birth as details mentioined
overleaf has been verfied and found correct. Verification report has been endorsed on two photocopies of the Mark
Sheet/Education Certificate.

Date : (Signature and Seal Impression of the Officer)

Running enclosure Entry

Sig of Screening Dir...........................................................

 CHARACTER/PRE-VERIFICATION CERTIFICATION

1. It is certified that Sri ........................................................................ Son of

............................................................................................. Caste ...................................

resident of....................................Mandal............................... Dist .......................

whose signature are appended below is known to me for the last ..............years.

2. To the best of my knowledge and belief:

a) He bears a good moral Character
b) He has not been convicted or tried by any criminal court.
c) He has never been imprisoned.
d) He has not been dismissed from any Govt. Service.
e) He has not been serving in the Army/Navy/Air Force/TA/Police.

NOTE : Please note that incorrect information will lead to undesirable Candidature.

Witness No. 1 Witness No.2

Signature:............................................. Signature: ..............................................

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

Address ............................................... Address ..................................................

............................................................. ............................................................
............................................................. ............................................................

Date : Signature :

PHOTO NAME Name :

AND
Place : DATE OF BIRTH Signature of SHO: ...............................
PRINTED DULY
(Signature of Candidate) ATTESTED NAME (CAPITAL LETTERS): .....................

OFFICE SEAL
 FAMILY PHOTOGRAPH - 6 x 4, COLOURED
ATTESTED BY SARPANCH / MRO / TAHSILDAR
SIZE - 6 x 4

Sl.No. Name Relation Date of Birth/Age

Date........................... (Signature of Village Sarpanch)

 UNDER TAKING CERTIFICATE

EXZy o ^o uN z oy| zz zz NZ {uN EuN N N

utz \LTz \z uN Ey| LMb 1950 E{ Ey| u 1954 utz Tz @
oy| EuNy GzO uo Nz z ^z o ut T {

I am aware that on enrolment into the Indian Army, there will be certain
implications and restrictions on the Fundamental Rights guaranteed to me by the
Constitution of India as per provision of the Army Act (1950) and Army Rule (1954)
I have been briefed about the above mentioned provisions by enrolment office

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H@@ H=x `Hx<#. ''~`^= ~*OQik *sK|_# Pi H
1950 =i Pi ~ 1954 #O^. Hx =oH JkH~ `yO K|_`x `e<#.
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Date : (Signature of Individual)

COUNTER SIGNATURE BY ENROLMENT OFFICER

Place : Guntur

Date :