ATTESTATIONS FORM

WARNING

1. The furnishing of false information or suppression of any factual information in

who attestation form would be a disqualification and is likely to render the

candidate unfit for employment under the Government.

2. If detained convicted, debarred etc. subsequent to the completion and submission

of this form, the details should be communicated immediately to the authority to

whom the attestation form has been sent earlier failing which it will be deemed to

be a suppression of factual information 3-(i) if it comes to notice any time during

services of the person that false information has been furnished or that there has

been suppression of factual information in the attestation form his service would

be liable to be terminated solely on this ground.

(ii) the attestation of the candidate is particular invited to column Nos. 5,

11, 12 and 15 and he is advised that in respect of the persons mentioned by

him against these columns he must furnish full names, present age, date of

birth and complete residential addresses giving places of residence correct

names of the village, police station and Districts or House No.

/Lines/Streets, Toads and Towns. In the absence of this information the

attestation form is liable to the rejected.

ATTESTATION FORM PHOTO

1. Name in full (In) Block Capitals with aliases, if any (please indicate if you have added or dropped at any stage any part of your name or surname

SURNAME

2. Present address in full (i.e.)Village-P-O-Thana and District or House Number& Lane & Strict and Road.

3 (a) Permanent Home Address in full ( i. e. ) Village PO Thana and District or House Number and Lane and Strict and Road. (b) If original a resident of Pakistan the address in that dominion and the date of migration to India Union.

4 Particulars of places where you have resided for more than five years during the proceedings five years. From To Residential address in full

(i.e.) Village Thana and District or House Number & Lane & Strict and Road.

5. (a) Name in full address, if

(b) Present postal address deed, give last address

(c) Permanent Home Address

(d) Profession

(e) If in service, give the designation and official address.

(a)

(b)

(c)

(d)

(e)

6 (i) Nationality of:

(a) Father

(b) Mother

(c) Husband

(d) Wife

(ii) Place of birth of (a) Husband

(b) Wife

(a)

(b)

(c)

(d)

(a)

(b)

7 (d) Exact date of birth

(e) Present age

(f) age a matriculation

8 (C) Place of birth, district and State in which it is situated.(d) District and State to which you belong.

9 (a) State you religion(b) Are you a member of schedule Casts, Scheduled Tribe/Backward Class of Haryana, Answer, yes or no. and if the answer is ‘Yes’ State name thereof.

(c) If Member of a Schedule Caste State Your caste and if member of Backward Class, State Your Class

(d)10. Educational Qualification showing places of education with years in the years of School

and College, since 15th years of age

Name of School/ College with full Address

Date of Entry Date of Leaving

Exam passed

11 If have any time been employed give details Designation of postPeriodFull address of the held or description from to Institution

12 Are you an Ex-BCO, Ex. JCO or EX-servicemen of likely to be release if so State the (i) officer (ii) junior Commissioned Officer and (iii) Other Rank besides indicating the date of entry and release in the army;

13 Have you ever been convicted by Court of any offence if the answer is yes the full particulars of the conventions and the sentences should be given.

14 Name of two responsible persons of your locality or two reference to whom you are know with Full address

15 Are you married, if so, please State Number of living wives you have (this person only)

(Certified to be signed by a Gazetted Officer or member or Legislature or other authority

prescribed by the appointing authority)

Certified that I have known Sh./Smt./Miss ________________ S/oD/oW/o Sh.

______________ for the last _________________ year months and that to the best of my

knowledge and belief the particulars furnished by him/her are correct.

Signature

Designation of Status and Address

PlaceDateAddress in capital words inWhich the candidate desire Further intimation