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€tut : (6lecur"ft +t6t)

(For use of Applicants in Employment)

Forwarded with the remarks that the above statements made by the applicant are correct to the best of myknowledge and behalf, and this institution I orgartrzation has no objection to the candidature of theapplicant being considered for the post of applied for.

Date:Place :

(Signature)

Head of the institutionDesignation :

Address:$

Mobile No :

a{l cit[de c13 alRaRdl.

cittrar

dttll ottc{l{ Gleqrr-I l-t|.} qq"u?.,r] ( GLeqtt Q.ar"{l uil trir{.d[, ?4ru ill oftsqt'{l 4[&.)

r.. Gileqrt ut?!)tt2tsui'0 +tqd[ Rctal sto€Iui ] i,ti.sst{l etadl. SltJ t{gt ut'j urc{l a ttu{ }aqsl s?qr 't[$. t'eil. atcg uscj't €].q eri atcJ uscj ae{l dl-t il\a etflaqi.

r. l{R[it\ar+i +tqs{l ldcra] eerlqdl cra{ D. +i1gl Qct,it actr"j aen utqi } ut+re u?Ur{:tg

Quttgtt:+l O.cttui rrtt.teL al$.

g. il.s s?cil. crg vcqrrrrL {tb uttp sectt :{lcrat Gleqtt U.il.s vca[r,iL {t} uart r{etJl ut?g)

srqt'ft r.BiL.

x. GD.ec& qRaHdt"tL dc,mtJa ,,sggu.ac.in,,l{re{l G.a{a rrnUgl.{ st6'tctl.s sfl aat G"qa stet

r,rtUglrl'ft {!.gl g-Ia-Islrft 6qaiLct:{i etd ut?!) sfl ctsit.

q. 'fttr erfQ.at gutgtualzqqrqas/e+arafl'fl GLeqrl +cru]t|.Q.a sta dsct]. ctEL .{oat G.stgt

r{?Uu2rs utD. rrrls uril.et sr.{.r. *1. iltJqqr 13{ u{qt'"tiL'ft uuutQ.a'isetL ?4a.zute{9{.t

[dstgt ut?Urt2ts tttD. {Lsaqtui qta.et d[b eta{a]. ut?!)q2ts @.utrgu dctt{l rltqel'tG.

(r) r,r?Ulrr2rs q? ul.ar'u arSat.'rt qtil.uLl +tttjct'tt gLar qlar$a. gLat rrt Gil.eqtl +t6[ stdt.

(r) cr"qar{rrt ur} O.u.rLu.dl.d. 'tt U{qt',{a"{i dsa.

(3) ut{, mR.zrrrl. qrdc(faat Glecnil ut}'tt tt[L Uutgtl{a"ft "tsct.(y) m.. qi. e1.u. qcl't 6D.eqrt-I :+tb"j '6aa qcil' r{l nqta.tt or. Ecu. t icl"tt Ul.ttqtqa'{l 'tset.(\r) {ru f,Rs z ut{Rs fll rlet*a Gil.eqtt ofqt r,ri\dt qe{ uqtgtqadl dsat.

( s ) icil.crs /q{re'il.crs /$raL:+i qfl at{ clgtuas'{l asa.

(o ) rdrcr.s /ut{u.t cts / {trril{i q{At{ Uu.tqtqal"{l asa.

(c) ?{{aqdt UrttqtuaL "ft "t8at.(q ) rilat"1 our+-+tr'tr:{Larq urr,|.$ qi.

s. GL€,cnl r,rtqqr'ft E.tl l{|.f(l.0. rrtLdt r,.r.rr{1. esL qEqr ?.{?Uq2rs:{i. r-ricfct 4{l ut[.r.ft2[dcta]

gutctcttit uat[{ sta.se]. r{izqerqr tR"tRdti cft}t5[ e]tctt"tl. uqtu sta rsil erti. i. tat'trra ruqil. al., UrerF.s snLdl, QorQ Ucu.stcr, G.u.Es crilt a{t:{ r+t} c-Itanqs orc].. ogul ruar

Gil.e,crri. gReffidt c,r[dtar l+r] cLreuqs otrd[ arsc]. qa. rL Gil.ecrr ?l%'?{ +r?st?'{l il.qrui

csQf. al., L{"ft uril. rruarfla{ qrtet dqt:{l u.t.LaL.

o. dtdt uterqr r.ussafl {tR qR+trdl ur erugr eu.qqr ua{d s?ou.? Gil.eql c'kcuars oreL.

itl'r.Ll'"q U?t'tL4L

c. sr&rtar{is ?rri Yca['j at4:

Xbttar+l eefaa srlqtsttasHiS rli mUt"j ottlt, tt?g)q2.S{i *q€ ee[c{.cLL. !

e. r{eu +c{lsrrqr'{l Ecdl ar{lu,

(r) Kb?rcr:{i ec{Qer ?rr?U tc{lsr?c{"ft Drc{l at{tu i{qqr L.r&at 'ga+tQ.q, r{l citGle

cJ3 gRafildl, it?sr{ q]c.[L]s'fts ]rqu, JLgsU?, rT[U?r.' i. qA. a {i. aqtat sttt

( Registered Post ) €{[ u?Urt2ts :+].sc{l uuuqi.

(?) u?U r{isrr.u'{i Dcr{l at. oo,/ro,/?ots tbal. elt?otte {A.a rtrur,.tL tcnsteqt:{ sqt.tef 't[$.

ro. i{?U $[

(r) q?Uq2rsrri ueu {. "[t [d.or.It.{qea{ e,tttqdl, 6le.rrt-IiL r{?Uq2t5 +ttE qn&ttau.l

eefQa F.ara r,rtu fl otr.r.r'ft ebe].. ( l,( l%?lctou. ?rt{. x(}., +tuRg qa flaGls

{l qura crcd,u aerr artflRs {Li" rdetscr GLeqtilrL u?gt?dtt u.t.{lt|.a rlct.tttj

lru mcEttaql ee[.a[ u:+tg].'ft {l"[t ottc{d rrt{u?qr.'{l ?Ee].)

(e) uLil.lilct { c(&rra uR.g erar"ft arflu qdl u{etila S[:{t"s ttw €II a+tqt"ft t.}e]..

(flqr"s ttw"{l qlun atu{, +t?.'tLi, nrtctsttas{is ?rti rca[i 'ttq eetl"t"Lr GAetLtti.

?tc'iLcs ?rLL!.Qtlti ?JttQ E)

(g) fl]t|."s ir.t€ "gcrirQ.r, a{l citGie cJ3 qaai{d[, +ttsrfl lLc-0.]s'[is ir.t+t, rlgsu?,

cittrtt.' .'it ou:{"tL l.uet rQ{l Rcrcit cqtet elqL ctLttil..

(y) ett?cr acst?e[l rA?U s?ct Glecul Rata {t at?ctou. qsttJsF.at r{qq[ ottdlar ?t1rRct

r{Ecu. ar?cr n?srra{l'rt daAQ{ sL{ui. ?rltt s?tq.d[ dEt ?rtt.ctt. 1saqu"{l riln uelu

ets r,ttur+as +ttO. rLsdl.

(q) ?rL rLs stat ag vcutr,tl r1t} t{ag stct eLatA[ ue)s r,pp ut). 6leqt Rata

r,t?u {t otr.u'ft r&iL.

(s) ?r{LiiL r,t?U {t t{?tctctt tte{ctl. fi.ata ?r{.rgl { actt<t ?,t?!)tt2ts Qutegttul d.cLtul

r{t.rel d[.}.

(o) tt?U { +ctt'[l r,trU"{l re0H.'tsa (Advance copy) ld.uttgttui d.att1 <[b.

(c) qRcrtildl *rr ufil.filcr {t Q} {'tluilSr, ''{].*aa r.,LSr rl€rq.t Ls r{lsttqt{ ?,ttc{sl {tl.(e ) dil.Rct fl s-Itluqt ritfcll:{i qea stcttqi r,{.tcl 4[8.

t t. 6Le,qtti 'tt{,(t) r,rasell rt3 s{i 6Aeqt ulat"j 'ur+ r.,ri. O.ar'j 4r{ ?lir)Urtl (sr'ri/tcum./smt. Qfl ettcl

uscj rrr'{ii) }O.act u.aili. .1E1 c1rrt.ft{l (stzgqr{zaftq.lt Qfl arc.1 qsrj ttu[a.)

1't?Ur{2ts ciEt qRFI\a{i. $t\a eq[.t.tt.

(t) HQgat 6Lecut-IrL F.at'j atuzufi"j .'trl+, g:+t{za{l:+.{l Egl c-itcJ qsd[ o{.c'tct

I'r?!)q2rs aar rrRQl\ar+l r,r1s ee["rd[.

(g) Gil.eqrtott ott:+r+i, r,tasu.l b u"ai lt$t ertra ofar al R dc'I+t y?tq[ r.,rtp ut0. u1s<,ts.rt.

ta. r{1 catA€t?{ tt?sttH:

(1) 6Leqtl q>1caracst?i cslai dEt sta{{l +t?c'u.i ([Q"t s-Is u[Ed) ?rt?Uu?ts dert

qRQl.ta:{i tu{.qee{ €,e[c{qi. !

(r) GLeqrl rracarcrcsle r+[] ur?uq2rs tttO. qLatdl ott]t ut]. +tr'tt{atr4 rlta d[{a

crq.?i aq il.lftxro il.r{t qr se'j utoil[3qi rrae+ ulsaat"j t&t].. ctL rr.r.rqi uto{tRqi

{tscrctrl1i r,1.riL dG A goe Ucu.sra {r}aL q1 r{a/r{Ectt ut€rF.s s+tl.d[ rtt}'i.

uQ.erqa uH.a{u? "r[qg {4. a] gRatildt i\tjrrqt +i*Lcitui. crcuqer? t$it "t[8.

(g) utatl+tr+i }tgtt,(t) Gil.eqtl qLat't|. ua"ttr{l{i turt ugt }rgtt €{ta{ ertt }t$tt ertra tte{l{t"{l,geuQ."t, a{l cTtGieclg qRqHdt, ursr{l ritc-fl.}s"{ls }uqu, u.gsg?, oilt{tt.'i(,ttrt, 'tqi ueari, 3r"j utati, qn&tta g{s, erca{t'j atu, rrtq. suis Ruv 4{Rcr.iL r,rls erfldli I ."tfll dO.a ttgr sidi. ut.{l xqt "t[$ stqt€Il cr] gLtj qa

c-\tcrcQ ctit aL qRaRdt"tt r.ttqetfl t.lil't[$.(t) crL rLs srat ag rcurrril rnb i.,ttu sta.sel..lL U.O.s crca{t r+t} 6l.e,cttl qaJ[

qetrr qaLeii qRaHdli +tt'ttui !tgrt'[l nnqt stat'{l tc}a1.

(g) 6Leci1l riLat'u 'tqt urorL qa uAr idl .ar.rurt std[. XRaRJI GLeqtr'tt

creetrd.ct ut"t{"ft "tltr rtrlqr Wcu. uard Et E, oai ugt. orecttd.a nt"ttil

{:tca{ecst? +[.] ud a1 gRaHdt"{l s]tf qr.ttc*et{ t.Eit 'tl$.C.g. %"q atflU'

(ur) (t) 6Lecut ?4?pq2rsti. ,{lat"{l ra at{lu eertdta. cr"{ atflq<t i. u{l.gtua"[l

otsct rt?!) utO. rrtctear cr{lsdl.

(e) aJRcrffdL ra+ at{u'u Wrqt ur} rl.u.rLu.dl.tJ. uurqtql ?r Htoet ttD. E,

uicl rLu.rlu.t{1.d. vl+rqrqaul eefda cr"{ atflr,t uldt €Ict'j 6Le,cttt rtti .iL

+rau rtQ.sr{O. uttQct .ra d{i ur.O.qru u:Lqtq:t asa l+Lsetdl. rrttqt ctq rli.r,ld[.t+t'n uurgrqa{ r,rQ.stflA +q€ {a tgttQ.ct €f{ AtlA }, i.ut].il.

lflsgdara trL+t.rL+t.{1.d.) } l"{l q{atq tn uHtqru2t aqtil.et D r.,ri rtlat"fl

+rl+&t ?V srct:{i rrtdet U?cu.ot rllult 6Le,ctt"{l utdl rro{ at{lu

D, * r1n Lfls.1O.ua (rLu.rL+t.{1.d.) } i."ft +tr+sa q{at'tt

u:tqrqa{i eerla.ar r+r at{r't stat gdl D i.r+ ut'r.c{.ta. gtcj sttgt B.

(c-t) Gut:qncleraqi rguQa ar{lu llra atret q{., :+ru r.,.r.i. [d,.ru rrqurr"{l 6:+t rrttur"tas

ae{r qRfiL\aul eafq.dl

r.x. r,rqt. qrt[A, rtq.er'taltR., ur:{Rs l'^ta. e1AQ.s fla. quta qct'

(r) ur{. qnt}., u.{.r+qrt[i., nt:{rRs r,ri elaQs {L qtsta crct Q4lat I GLeqtt e].a{ Iun3luasrti qqea{ eertcrql. tsle$ugt {rlcit:{i. ur'j utc-ft ar truqi ] aqst srqt 4G ',{qt '

atcl uscj "t€ll' rL{ etflaqi.

(?) ?rr{. m[i., rt4.rottt[i., ilr{t[ts rrli flatQs {li. quta ctcl r'^icf'tt s].ctu{i I R

?rrotrl{cr seil.dil. e:rlQ.a'rtd €fe{ aL qrucrr ell r{dtua GLeqtt a{t}'Tt ettat Lnqqt"il. etql.

srqt{i r't.LtL af l. {"et t.tsel d[c|.

(3) unq u1q,{l 8 L r{dHa sar"{l i{Ec{t fdaurdtHa qtcan utl. OLeqtd"t]uql dI af

I il\a {i. r,r.tear eefaqi. (s-Itjqgr {cr].citHi ur"j utcft at ttuqi } aust st.tt't[B)

(u) ?Jr{. m[i., rtq.ronnfi., +t:{Rs r;ri. elAQs flL quta .tct a{} atot Lrnctql 6?dectL

Glectl R"t u{el"r{l ua{ r^r[0.sr{ arrr G.e{a argarul urtqqtql urtQet qnh. uruqtqa'fl

.,tsel ur?pr{as ut0. qqea{ urlct st.t"ft tctsef. (aett 3a3ui UettSct .ruR riln Ulttqtq2t

rg sr.nar r&e1) d,r?uq2rs +u0. rrttqr u{qtuaf utLa stctt:{t r-ttQ.a a.@ etu ,it.r{ru( €I[ u{qtqa]" t<{lstt"tt{ r,nqsl.'i[.g.

tLt. rl.tu f,.G.s ztu{lRs {a. r,teua 6Qeq.tt,

:+rU f,Rs z err{Rs {i. r}retgd Gl.ecrtt Q{"tt I 6Le,cttt elet a. ut?Uq2ts:-Ll r,tqeq

erfla.j crEr u$q urQst{zutstfl e].f&.aazl$set c'itS'tt U{qtr{a'[t 'tset rlttU +tt0

utls dlsdl.

t S. ottctRS..t,

6l.e.ttt' (t) otea'ft ottctRs, utEcLL

(t) iut6[Al U%l%o.t, t{Eq.

(r) Eat"taL U%l%ot, r4actL

(v) fid.aqr R.{[il.a * auraqi sre{}[ quq.a s?cr.dtl tlrtetell r., u"e4rtt{

lest qBft crttta{i r,ttdet elqL crldil..

(rr) if,6t attac{lar .art*. } I oura{i srq}[ q+tqr.e 5?9tt6il. tjttetell

qrB*tt.'t, oticcttbtt, ot{, s.ltcist, ]oa11, {q.[st *cr r1d rrtftst"tt beiL, tigsa

u%i+rcu.s atuF.qr, srx{lqr, tleilQatt€fi urcniar sfli rrtQat efqr d.eFl,

ui.1 tat sqi.s ( ?, 3, u uli rr ){l t^ttqar 6Leqta-I'tt B++tt{l +trstt qt2(rtt

u:lrqtq:t r.ruQet elg etld{.

altr, * 6Leqtr'u Br+urri. qt2rcu. u{rqrq1 q{t 6tu i.qt 6il.ect?{ ut?Uuas gG.afildl

(durtgnr+i. d.eL rli. *. RuEs {t} a.:{'rt at{"{l arat{qr srctt}l.i z-tt.tiL al ettq il?st?

L:{'[ Brutulqtaat ul+tgt\t2t rrit.t.tt'[ gtta. stl+qar6 RtEs rrrtqAt.

c.o. A.&Qls atarsra'

qnbrta{ l+lcqt 1nc,r"ft q{t elaQs citarsra'{l +ir1ql [d.cra] Gil.ecut q?Uu2rsq[ r.,tcteat

e,r[.rd[ d€rl ur?Uu2rg:{[ vqtd.ct eu.a{stctou" tt:{el't:tl $[r.et].HizflcJl'tt u:{qtqalr'ri.zqerqt cggruas'ft otscr r{?!) +u0 urls o{lsdL.

tC. utqJQ|.a:

q(clrtaui ulcen lraal r,rqora tr?tcr,n? Gle,qtl L rric-I,ft rtlql (dcra1 ureuqasrtl

r{qeat eeflq.dl a€rr i dc-I,u Ult|'qrqa]"ft or8cr ?4?U nrq r.,.r.e1s o{tsdl. qnctsrraui ?^{arc{

'u. r{[rtcL:{ .,rtcail. e]ar al ugr GLecut rrr4c+a tr?lcrcu. e]ar al R rricf'[l [dcta]. ut?3)i{2ts

ae{t uR[g-t\e{ ecrlcrdl.

te. Gile.rrr'ft n6L !Gileqt t,t?Uqas:{t l{qea{ u6[ srdl. 6lecr.tt'{i udl .rcrr'u. ?rr?prt2ts fd.uttgttui

d.qtl+[ rru.rit q[.].

QO. oil. ctit{. u:{.Qttt2t: (No obiection certificate):

"cJ?r?tci nrstrst4t +trsr{zrr.r.tl +rrst{lz+trEr.? qs?riscu. SIqTtst'tziq'{l?,iLut il.ctt c,tc(c{.at

ql8sr{,rsdqtfld[, at?ct +r?sr? r{€{qt rq.'ar rrtq].4 uasttat utstfl,/?,ttl urst{tz+ttstt

cskscu. sl"qTler'rziq'{l?,Lqt ilqr orqrtqdl t,tf0.st{zs{qrfl?rild. riLat'tt

fdoucrzr,uarzsL{ rtr?gcr r^tru +"{lar.u'ft Dc<[ arflu qtil tdr. a {ta qR.tRdli qrpr+Lsarqr"ft r.ErL.

tt. cLtctc{Es, 3

Gileqrt-Ii uteft La.rgft rltuotr+i. rrrtd. D ], lrrl.rL r{euqasiti s-ItJqqt Vstt'{l rrLdl

ut[B.ft es[.{.dl dG, a.q?r uuqtus rul.|dl gur.tdl a[$. Gqtla ].r,LrL t3r ste rr+tct

eurQqrl B a,ft Ur{q.a asa{l s-Itjuqr {{tcitr{i qUrel } }rgtr r.Aerqr c'{le( s-IrJugr Lsr

srqt +lct uEct Lrrd.rL ruqr il.sr stctzr,r'uqdl e*uQ.rl ?E s?ctt +[$, 11 O.s ugt

c-u.G{.crau, A } aeII cig e*uQd.H[ qqqt i"{l UrrQ.a "tscr].qi sltlugr Usrr"ft qriLsttuj

r,rercrl. Q{crarudt ergu.a{ al i"ft iq\adt t3r stdl. crL sLtjqqt GLecut'1R+Rd[ attt

e-IR.a qnbr €ra.a €ler r{erqt Etq al.,

c.. R?ril"ft GLecrrfl rricl ildugr {i. aitca{al url-cr s?cu.,

?. ou.rr c,rec{li q{zu rrtr{ €La{,'

r. sltl c+ar.r.d[ etarQqr]. rE sut 6tu,

y. SIIJ r,r,ar .arffr. 6r?r teoLsqaell sru 1gl srrqi €Iu,

.r. r'ror.ero{l qlotcr grttqqt utEctt rrLar G.a.ea] ster 6Ia{,

s. i.urLdl GLe,qr{ rtt} s].rfqqr qfi.ar(La ] urqlda Gqtail"Tt +tcstr-I c{ltr]. €Laq

o. srLdl ul+a. s].rJ r,tq[i.a rutr,t].,tL Gqaitcr Elet €tar,

c. 6ar.r6[rriL{ r,tftla ottqt } rrl[itv ouota]. +tlcga"{l rricra ottc,tc{L

e. lr{zu rrisr+i iltjr-rgr {a"{l cltodEs l{rurdl,Sdl } r,t"ar 6Le,c.ttr'ft 6.trq0uleft "rsers?dl,g*ts, ctlrJs, srqe[i icr slelugr utQet ] cs+aG.G.a utQcr'0 l+ee sI[ r,,t.q+. qladla

srtt b sltJ uibQ.E {i. dsa Erqr } r,t"ar $l"ecnili,tser ser.r.u,ft c-IeRc0r,il Qfl sLtJqet

5IrR.ft r'ttqeqt qr),

to. gR.rHdt srrr uflflr"ft srr+cftfl di."u G.gsa erO.cu s{{r{{a. ur+qft srdl,

slttugr usrr"{l euflRs tjqn q€Lursdl, r,rE.u

tl. 6qe-Itct vLctctttJr,rhi. 6cawa.ct ets ure{cu. sLrJqqt g.t{ s?cr.r. } srtqqt li. uatr.t

sail €Lq iL GLeqrr '{Itr e,e[a.a QLat 6qrla r'uq].uuu itcret{ srd.udli. qta c{'ril.

(s) qRctffidl nrr I q{ec0"t Gl.ecnr a{} c].ratr?rg ottdl etsrit, t'ti.zr^tE.tt

(rrtl i.i qR+H{t a ad Sltlqqt rr{|zu } Ad qqr ?a3 UetsLcL rtt} star{l } Ssttrgaa utb,

ttl gh..r.ffdl snt dqtdtt sLtlugt qflat ] q{ecft r+t}, r,t4.

(?) ?tle{ u?st?.}orn'ft sltlugt'tLs{l l+i.il tt?st? sttt cLtcttatt urldl etstt]., rti-

1cr1 * L +trsr{l il.cu:{i r,tcr6ell qr eLar aL aL'u tdg.g +t1t-{a G.atrtl ut{+tt? QlHqictat

uctcr.t at6 e[ste]..

rQ. 6rre-Ea RcraLul Rtde stet Qlat g?cu ucEat qRalildlzuestt 6t?L

6Leqtta.zsdrl|.{a(t) rrttilq"u:+t {i Lrt'ft +ttil.+t +rta rrnt-Iqf utqctL }+r'tt Ustt rrttc'ti., ..

(e) dO.aqi. El"at dcl otutaati- .s4[ga tg seat, uti.

Gl Qtzu dcl Rera +tuq Hafletui 3c^rp ?yuncr sr.rr'{l ag rrttqqt]tl utqe]..

t€l6L: ciltrtt

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