Office of the Chief Commissioner of GST, Central Excise & Customs, Nagpur Zone
GST Bhavan, Telangkhedi Road, Civil Lines, Nagpur - 440 001 Telephone No.0712-2565375 Fax No.0712-2561887 (ccu-cexngpr@nic.in)
    To, All candidates as per list enclosed.     Sub:   Recruitment to the post of Tax Assistant under CBIC through Combined Graduate Level Examination , 2017-reg.                    1. 2017 , &   You have been nominated for appointment to the post of Tax Assistant and allocated Nagpur Zone by the Cadre Controlling Authority, Bhopal Zone on the basis of Combined Graduate Level Examination 2017, conducted by the Staff Selection Commission.  
2 .() & 05-10-2020 + 11.00 , . . . 0 ), 5-I : ; <
0   You are directed to appear before the Joint Commissioner (P&V), GST & CX, Nagpur-I on 05-10-2020 at 11:00 A.M. for verification of documents.   3. : () & 5 ( ; 0) 0 I C & I : C ; ; 0 5 0 ; ; 0 C 0 G 0 0 G 5 I 0 : () & ; ( 5 ), )& , ,   ( 5 ) C 5 ; 0 P 0   The candidates are directed to submit the duly filled in Attestation Form (in
File No.GCCO/II/(3)/17/2020-ADMN-O/o CC-CGST-ZONE-NAGPUR
three copies). A copy of blank Attestation Form is enclosed. The candidate shall get the blank Attestation Form photocopied prior to filling it up and make entries in all the three forms in original. A recent photograph shall also be pasted on each form which should be self attested. All the entries should be made neatly and no column should be left blank. Further candidates are directed to bring the original certificates/documents related to their Date of Birth (matriculation certificate), Educational Qualification, Caste Certificate and Disability Certificate, whichever is applicable, along with 3 set of self attested photocopies of the same. The Caste Certificate and Disability Certificate should be in the prescribed format.   4. : () & C )C )C , 0 “ ” C 5 < 0I < 0 I   Further, the candidates are directed to undergo medical examination with reference to this letter and produce Medical Certificate of fitness for Government Service obtained from a Medical Officer not below the rank of Civil Surgeon or a District Medical Officer or Medical Officer of equivalent status of a Government Hospital, duly countersigned by proper authority wherever required along with a copy of the "Statement and Declaration" made before the said authority in the enclosed format duly signed by the issuing authority of the aforesaid certificate. Further, you are directed to get your recent photograph pasted on the medical certificate of fitness and get it verified by the said authorities.   5. Candidates are directed to mandatorily produce a "Negative Report for Covid-19" test at the time of appearing for the document verification, issued by an ICMR recognized laboratory not more than 07 days before the date of documents verification.   6. : () & < 5   The candidates are directed to bring with them one of the original Photo Identity Card on the stipulated date.   7. : C &
File No.GCCO/II/(3)/17/2020-ADMN-O/o CC-CGST-ZONE-NAGPUR
I ;   No T.A. & D.A. will be admissible for the journey and candidates will have to arrange for their boarding and lodging.   8. I C ) 0 : 0 I ] 0 G   In the event of non-reporting on the scheduled date and time, it will be presumed that the candidate is not interested in accepting the post of Tax Assistant in this Department and his/her candidature will be cancelled and his/her dossier will be returned to Staff Selection Commission.
  9. , , . . . 0 ), 5 < & I
This issues with the approval of the Chief Commissioner, Customs, GST & Central Excise, Nagpur Zone.
  Encl.: As above. 
  (MUKUL S. PATIL)
JOINT COMMISSIONER (CCO) Copy to:- 1. The Joint Commissioner, GST & CX, Nagpur-I.  2. The Superintendent (Systems), Nagpur-I for uploading on official website. 
File No.GCCO/II/(3)/17/2020-ADMN-O/o CC-CGST-ZONE-NAGPUR
 
LIST OF CANDIDATES ALLOCATED TO THE POST OF TAX ASSISTANTS IN NAGPUR ZONE THROUGH SSC-CGL 2017
SL. NAME EMAIL ADDRESS PHONE
1 MONESH TIWARI
JAIPUR ROAD, ALWAR, RAJASTHAN
HOSPITAL, BPO BAIYNPUR,
SONIPAT, HARYANA 131001
DAYANAND NAGAR, BAHADURGARH,
JHAJHHAR, HARYANA 124507
ASHOK VIHAR, PHASE 03,
NEAR SHITALA GAS GODOWN,
KHARKHODA, SONIPAT, HARYANA
NEAR STATE BANK OF BIKANER& JAIPUR,
BUXAR, BIHAR 802101
File No.GCCO/II/(3)/17/2020-ADMN-O/o CC-CGST-ZONE-NAGPUR
COLONY, GAUTIYA, NEAR
ENCLAVE, DELHI 110093
SHIKSHA NAGAR, PO-BANMNKHI, DIST:
PHOTOGRAPH
WARNING
Affix signed passport size (5 cms x 7 cmsapprox.copy) of recent photograph
1. The furnishing of false information or suppression of any factual information in the Attestation Form would be disqualification, and is likely to render the candidate unfit for employment under the Government.
2. If detained, arrested, prosecuted, bound down, fined convicted, debarred, acquitted etc. subsequent to the completion and submission of this form, the details should be communicated immediately to the authorities to whom the Attestation Form has been sent early, failing which it will be deemed to be a suppression of factual information.
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Thana&
District or House Number, Lane/Street/ Road & Town and Name of the District Hqrs.)
3.(b) If originally a resident of Pakistan/Bangladesh (erstwhile East Pakistan),the address in that country and the date of migration to Indian Union.
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b) District & Stateto which : youbelong
c) District & Stateto which : your father originallybelongs
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9. a)Your religion :
b) Are you a member ofa : Scheduled Caste/Scheduled Tribe/ OBC Answer Yes or No
c) If the answer is Yes, state the name of the Castethereof: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10. Particulars of places (with periods of residence) where you have resided for more than one year at a time during the preceding five years. In case of stay abroad (including Pakistan), particulars of all places where you have resided for more than one year after attaining the age of 21 years, should begiven.
FROM
TO
House No., Lane/ Street/Road & Town)
Name of the
District Hqrs. of
(if employed,
Father
Mother
Spouse
Brother/s
Sister/s
12. Information to be furnished with regard to son(s) and daughter(s) in case they are
studying/living in a foreigncountry.
by domicile)
studying/ livingwith
mentioned in
previous
column.
13. Educational Qualifications showing places of education with years in Schools
&Colleges i.e,. from S.S.C./ Matriculation /10th andonwards:
Examinatio n Passed
Date of Entry
Page 3 of6
14 (a) Are you holding or have any time held an appointment under the Central or
State Government or a semi-Government or Quasi-Government body or an
autonomous body, or a public sector undertaking or a private firm or
institution? If so, give full particulars with dates of Employment up-to-date:
PERIOD Designation,
Emoluments and
nature of
under the Government ofIndia/
a State Govt./ undertaking
Govt. of India/ State Govt./ an
autonomous body/
University/Local body:
Central Civil Services (Temp.Services
called upon to explain your
conduct in any matter at time
you gave notice of termination
of
before your service actually
(a) Have you ever beenarrested ? YES /NO
(b) Have you ever beenprosecuted? YES /NO
(c) Have you ever been kept underdetention? YES /NO
(d) Have you ever been fined by a Court ofLaw? YES /NO
(e) Have you ever been bounddown ? YES /NO
(f) Have you ever been convicted byaCourt YES /
NO of Law for any Offence?
(g) Have you ever been debarred from any YES / NO
examination or restricted by anyUniversity
or any other educational authority/ Institution?
(h) Have you ever been debarred/disqualifiedby YES / NO
any Public Service Commission/StaffSelection
Page 4 of 6
Attestation Form ?
NO University/Institution or any other educationalauthority/
Institution at the time of filling
this Attestation Form?
/Institution under the Governmentorotherwise? YES / NO
15 (ii) If the answer to any of the above mentioned questions is ‘YES’, give full
particulars of the case / arrest / detention / fine / conviction / sentence /
punishment etc., and or the nature of the case pending in the Court /
University/ Educational Authority etc., at the time of filling this
AttestationForm:
(i) Please also see the ‘WARNING’ at the top of this Attestation Form
(ii) Specific answers to each of the questions should be given by striking out
‘YES’ or ‘NO’ as the case may be.
16. Name and Address of the two responsible Persons of your locality or two references to whom you are known:
(i). (ii).
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I certify that the foregoing information is correct and complete to the best of my
knowledge and belief.
I am fully aware that by providing false information or suppressing material
information while filling this form, the authorities have the full right to terminate my
appointment letter and I am also liable for appropriate criminal/civil action as a
consequence.
I am not aware of any circumstances, which might impair my fitness for
employment under Government.
Certificate to be signed by any one of the following:
i) Gazetted Officers of Central orStateGovernment :
ii) Members of Parliament orStateLegislature : belonging to the Constituency wherethe Candidate or his parent/ guardian is ordinarily residing
iii) Sub DivisionalMagistrate/Officer/ BlockDevelopmentOfficers :
v) Principal/ Head Master oftheRecognized : School / College / Institution were the candidate Studiedlast
vi) Registrar/DeputyRegistrar/ Assistant RegistrarofUniversity :
Son / Daughter ofShri_ , forthelast
years months and that to the best of my knowledge and belief the
particulars furnished by him/ her arecorrect.
Place : SIGNATURE :
Date : Designation :
i) Name, Designation andfulladdress : of the appointingauthority
ii) Post for which the candidateisbeing : Considered
. . . . . . .
Page 6 of 6
C E R T I F I C A T E
Certified that I knowShri/Smt/Kum
years months and that to the best of my
knowledge and belief he/she bears a respectable character and has no antecedents
which render him/her unsuitable for Governmentemployment.
Shri /Smt./Kum. is not
SIGNATURE AND DESIGNATION OF THE GAZETTED OFFICER .
C E R T I F I C A T E
Certified that I knowShri/Smt/Kum
years months and that to the best of my
knowledge and belief he/she bears a respectable character and has no antecedents
which render him/her unsuitable for Governmentemployment.
Shri /Smt./Kum. is not
NOTE: To be signed by two different Gazetted Officers.
ANNEXURE – II CANDIDATE’S STATEMENT AND DECLARATION
The candidate must fill the below columns prior to his/her Medical Examination and must sign the declaration appended thereto. His/her attention is specifically drawn to the warning contained in the NOTE below:
1. State your namein full : (In BlockLetters)
2. State your age and placeofBirth :
3. (a) Have you ever hadsmall-pox intermitten : or any other fever enlargement orsuppruation of glands spitting of blood, asthama heart disease, lung disease, fainting attacks, rheumatism, appendicitis ? OR.
(b) any other disease oraccidentrequiring : confinement to bed and medical or surgical treatment.
4. When were youlastvaccinated :
5. Have you or any of your nearrelationsbeen : affected with Consumption of Orofula, gout, asthama, fits epilepsy orinsanity.
6. Have you been examined anddeclaredUnfit : for Govt. Service by a Medical Officer/ Medical Board within last 3years.
7. Have you suffered from any formofNervousness : due to overwork or any othercause.
8. Furnish the followingparticulars Concerning : your family
Father’s age if Livingand state of his health
Father’s age at the time of death and the cause of his death
No. of brothers living, their age &state of health
No. of brothers dead their ages at death & causes of death.
I declare that all the particulars filled in the above columns are true and correct to the best of my knowledge and belief.
I also solemnly affirm that I have not received a disability certificate/pension on account of any disease or other conditions.
Signed in my presence
SIGNATURE OF THE CANDIDATE
SIGNATURE OF THE MEDICAL OFFICER
NOTE: The candidate will be held Responsible for the accuracy of the above statement, willful suppression of any information by the candidate will incur the risk of losing the appointment and if appointed forfeiting of all claims of Superannuating pension and Gratuity.
CERTIFICATE OF PHYSICAL FITNESS I have carefully examined Sri/Smt S/o/D/o/W/o
a candidate for
Employment under the Government of India, Central Board of Indirect
Taxes & Customs Department as _____________________ and cannot discover that
he/she has any disease, communicable or otherwise constitutional affection or bodily
infirmity except that his/her weight is in excess/below the standard prescribed or
except I do not consider this a disqualification for the employment in the
office of the Central Excise Department.
His/her age according to his/ her own statement is years
and by appearance about years, I also certify that he has make of small
pox vaccination.
Height Weight
His/ her vision is normal
Hypermetrophic( ) Enter the degree of defect and the strength of correctionglasses Myopic( ) Enter the degree of defect and the strength of correctionglasses Astigmatic (Simple ormixed( ) Here enter the degree of defect and strength of correctionglasses.
Hearing is normal/defective (much or slight)
Urine: Does Chemical examination show 1. Albumin, 2.Sugar, 3. State
specific gravity
Date :
Place :
Signature of the Candidate
Certificate to be signed by any one of the following:
TO BE FILLED BY THE OFFICE
C E R T I F I C A T E
C E R T I F I C A T E (1)
ANNEXURE – II