GOVT. OF INDIA

MINISTRY OF HOME AFFAIRS

SASHASTRA SEEMA BAL
RECRUITMENT RALLY FOR CONSTABLE (GD) (MALE ) FOR
THE BORDER DISTRICT OF BIHAR STATE

‘Sashastra Seema Bal’ will hold Recruitment Rally for male candidates belonging to
Border District West Champaran, East Champaran, Madhubani, Sitamarhi, Araria, Supaul and
Kishanganj of Bihar state for fill up 528 backlog vacancies in the rank of Constable (GD)
CAPFs for the year 2012-13.
1. Vacancies:POST

SC

ST

OBC

TOTAL

CT(GD)

198

45

285

528

i.
ii)

iii.
iv.
v.

2.

There is no vacancy of General Category as such General category
candidate may need not apply.
The number of vacancies are subject to change without any notice and
may increase or decrease depending upon the position at the time of
final selection.
The posts are temporary but likely to be permanent.
The recruitment will be conducted on all India basis.
Selected candidates are liable to be posted anywhere within as well as
outside the Territory of India according to transfer policy of the force.

Pay Scale and Other Allowances:
Pay Scale:
month.

3.

(Pay Band – 1):

Rs. 5200-20200 + Grade Pay of Rs. 2000/- per

Other Allowances:
The post will carry Dearness Allowance, Ration Money, Washing Allowance,
Free Uniform, Free accommodation or HRA, Transport Allowance, Free Leave
Pass and any other allowance as admissible in the Force from time to time under
the Rules/ Instructions.
They will be covered under new restructured
contributory pension scheme. A candidate appearing in the recruitment test
must mention / intimate if any criminal cases (s) is / are pending / contemplated
against him in any Police station / Hon’ble Court.

4.

ELIGIBILITY CONDITIONS: The candidate must fulfill all eligibility conditions at

the time of reporting for the Recruitment Test. Candidates appearing in the
examination/ awaiting result/ educational certificates, need not to apply.
A)

Age Limit

(i)

18 to 23 years ( The crucial date to determine the age will be 01-01-2013)

Note:

Only Matriculation certificate will be accepted as a proof for establishing age of
the candidates and no other document will be accepted.

--::2::--

B)

RELAXATION:

(i) There will be relaxation in age for SC/ST/OBC (i. e. 5 years for SC/ST & 3
years for OBC).
(ii) The upper age limit relaxable up to 5 years in case the candidate is already in
Government service. Government employees / servants’ claming age relaxation should
be in possession of a certificate in prescribed format from their office in respect of the
length of continuous service which should not be less than 03 years in the immediate
period preceding the date of recruitment/ date of receipt of application. They should
also continue to have the status of Government servant/ employees till the time of
appointment, in the event of their selection. The candidate will have to produce NOC
form his department at the time of recruitment. This concession will be admissible
only where a Govern ment employee has rendered not less than 3 (three)
years’ continuous service in Govt. Department.

5.

EDUCATIONAL QUALIFICATION:
Matriculation or equivalent from a recognized Board.
Note: Educational certificate other than State Board/Central Board should be
accompanied with Govt. of India notification declaring that such qualification is
equivalent to Matriculation / 10th Class pass for service under Central Govt.

6.

STANDARDS OF PHYSICAL MEASUREMENTS
DESCRIPTION

OBC category candidate

SC category candidate

HEIGHT

165 Cms

162 Cms

CHEST

80 cms

WEIGHT

(Un-expanded)

85 cms
(Expanded)

79 Cms

84 Cms

Proportionate to
height and age
as per medical
standard

(Un-expanded) (Expanded)

ST category candidate

7.

162 Cms

76 Cms

81 Cms

(Un-expanded)

(Expanded)

MEDICAL STANDARD

The minimum distant vision should be 6/6 and 6/9 of two eyes without correction i.e.
without wearing of glasses.

Candidates must not have knock-knee, flat foot, varicose vein or squint in eyes and they
should possess high colour vision. They must be in good mental and bodily health and free
from any physical defect likely to interfere with the efficient performance of the duties. They
should conform to the medical standards prescribed by the Force and should be declared fit by
the Medical Officers of SSB.

--::3::-8.
Place/Venue of Recruitment Rally:- The recruitment will be rally based and the
candidate will appear for the recruitment at the place/venue of recruitment district-wise and
Tehsil-wise as per following schedule at 0700 hrs for their registration and documentation :Sl.
Name of
NO. Border
District

1.

2.

3.

East
Raxaul, Bankatwa, Harsidhi, Chakia,
Champaran Adapur, Ghorasahan, Dayal
Dhaka, Areraj, Patahi, Sugauli, Chiraia,
Sangrampur, & Motihari
Kesaria, Madhubani, Narkatia, Turkaulia,
Piprakoti, Mehsi & Kotwa
Paharpur, Pakri, Phenhara, Banjaria,
Kalyanpur, Tetaria, Ramgarhwa

Date of
reporting
for
registration
&
documenttation.
23-05-2013
24-05-2013
25-05-2013
.
27-05-2013

Venue
for
registration &
Recruitment
Test

21st Bn, SSB,
POValmikinagar,
Distt-West
Champaran,
Bihar

West
Sidhwa,
Lauriya, Bhitaha, Sikta &
Champaran Ramnagar
Bagaha, Thakrahan, Majaulia, Gaunaha &
Piprasi
Jogapatti, Bettiah, Mainatanr, Madhubani,
&Chanpatia

28-05-2013

Madhubani Madhwapur, Laukahi, Benipatti, Jhanjharpur
& Harlakhi
Phulparas, Bisfi, Ghoghardiha, Basopatti &
Babubarhi
Madhubani, Lakhnaur, Jainagar, Khajauli &
Pandaul
Madhepur, Lanania, Kaluahi, Rajnagar,
Andhratharhi & Laukaha
Sitamarhi Bairgania, Parihar, Parsauni, Bajpatti &
Suppi
Sursand, Belsand, Charaut, Majorganj &
Bathnaha
Runisaidpur, Pupri, Sonbarsa, & Riga
Dumra, Nanpur & Bokhara

23-05-2013

Sapaul

23-05-2013
24-05-2013
25-05-2013
27-05-2013
28-05-2013
29-05-2013
30-05-2013
31-05-2013

24th Bn, SSB,
Araria-1, Koshi
Project Colony,
PO- Bathnaha
Distt- Araria
Bihar-854315

23-05-2013
24-05-2013
25-05-2013
27-05-2013
&
28-05-2013
29-05-2013
30-05-2013
31-05-2013

12th Bn, SSB,
Kishanganj,
Near NH-31,
Biscut Factory,
PO & DisttKishanganj,
Bihar- 855107

Araria

4.

Name of Tehsil

Nirmali, Pratapganj, & Kishanpur
Pipra, Basantpur & Raghopur
Marauna, Tribeniganj & Chhatapur
Sariagarh Bhaptiyahi, Supaul &
Narpatganj, Bhargama & Araria
Sikti & Forbesganj
Raniganj & Kursakatta
Palasi & Jokihat

Kishanganj Terhagachh
Thakurganj
Bahadurganj
Kishanganj

Dighalbank
Pothia
Kochadhamin

29-05-2013
30-05-2013

24-05-2013
25-05-2013
27-05-2013

20th Bn, SSB,
Sitamarhi, I.T.I
Complex,
Dumra Road,
Sitamarhi,
Bihar-843301

28-05-2013
29-05-2013
30-05-2013
31-05-2013

--::4::--

9.
The eligible and desirous candidates of above mentioned Border Districts of Bihar
should report at the respective Recruitment Venues as mentioned in Para-8 for registration and
documentation for the Recruitment test. Candidates must bring the following original documents
with them for registration with one attested copy of each :i)
The candidate should report with duly filled in application form in all respect as per
Annexure-A
(ii)
Original Educational Qualification certificate and mark sheet.
(iii)
(iv)
(v)

Original Date of Birth certificate (Matriculation certificate for proof of age.)
Original Domicile/ Permanent Residential Certificate. (Candidates having temporary
residential certificate for education/ employment purpose will not be entertained.)
Original Schedule Caste / Schedule Tribe certificate as per Annexure-B

(vi)

Original OBC certificate as per Annexure-C.

Note :- OBC certificate must be in the format as prescribed at Annexure- C.
Two recent passport size photographs duly attested by gazetted officer. One should be
pasted on the application form as per (Annexure –A). The other photograph will bear the
name and signature of the candidate on the reverse.
QUESTIONNARIE FORM as per (Annexure –D)

(vii)

viii)
10.

STAGES OF RECRUITMENT :-

(i) DOCUMENTATION AND REGISTRATION: - The documents of the candidates reporting
with duly filled in application form in all respect as per Annexure-A and the copies of following
certificates/ testimonials duly attested from a gazetted officer will be collected at the Recruitment
Venue. The candidates whose documents are found in order will be issued admit card for further
stages of Recruitment Process. The date and time of reporting for PET and PST will be
mentioned in the Admit cards.
ii) PET AND PST : The candidates have to report for 5 Kms race (PET) and PST on the dates
given in the admit cards. The candidates will have to undergo the stages as under :(a ) PET :- 5 Km race to be completed in 24 minutes.
(b) Physical Standard Test(PST) :- Those who qualify PET will be screened for height
chest and weight measurements as mentioned in Para-6 above. ( Weight will not be a
disqualification at the stage of PST. However, it would be assessed for
disqualification during medical examination)
Note :- Physical Efficiency Test ( PET) and Physical Standard Tests (PST) will be only qualifying
in nature, and it will not carry any marks. Failure in any one of the events will result in elimination
at that stage itself. The date and time of written examination will be intimated to the
candidates orally by the recruitment board on completion of their PET and PST. The
candidates must ascertain the date of written examination before leaving the venue from the
Recruitment Board. No separate call letter will be issued for appearing in written
Examination.
iii)
WRITTEN EXAMINATION: : - Candidates who qualify the Physical Efficiency Test and
Physical Standard Test will be required to appear in written test.
(a)

(b)

The written test will consist of objective type multiple-choice questions. It will be of
100 marks and comprise 100 questions to be answered in Two hours. The
question paper will be set to assess the General Awareness, General Knowledge,
Knowledge of elementary Mathematics, analytical aptitude and ability to observe
and distinguish patterns and to test the basic knowledge of candidates in
English/Hindi. The question paper can be answered either in Hindi or English.
The cut off qualifying percentage of marks in written test will be 33% for SC/ST &
OBC category candidates.

--::5::-(iv)

MEDICAL EXAMINATION

The candidates will be medically examined by the Recruitment Board of SSB to assess
their physical and medical fitness as prescribed in the eligibility conditions. The number of
candidates to be examined will be equal to the number of vacancies, increased by average failure
rate during medical examination determined on the basis of past experience. The list of
successful candidates of written test, to be called for medical examination as per merit and
vacancy position, will be displayed on the notice board of respective recruitment centres with in a
week time from the date of written test. The Exact date of declaration of result will be intimated to
the candidates orally by the Recruitment Board on the date of written examination and the same
will also be uploaded in SSB recruitment website www.ssbrectt.gov.in . No separate Admit
cards will be issued to the candidates for appearing in Medical Examination.
(v)

APPEAL AGAINST FINDINGS OF MEDICAL EXAMINATION

If a candidate is declared unfit in the detailed medical examination, the grounds for
rejection will be communicated to him by the Chairman. The rejected candidates will obtain
Form 4, 5 & 6 from the Chairman concerned, if not satisfied with the findings of the Medical
Officer, to prefer an appeal for Review-Medical Examination with in 15 days from the date of
issue of communication in which the finding of the medical officer is communicated to the
candidate. The appeal should necessarily contain the following :a)
Review Medical Examination fee of Rs. 25/- only (non refundable), through Demand
Draft in favour of “PAO, SSB, MHA, New Delhi” payable at State Bank of India, Service
Branch, Delhi.
b) The fitness certificate other than medical form 6 provided by the recruitment board to the
candidates to appeal for Review Medical Examination will not be considered and rejected
straight way. The fitness certificate on Form 6 is essential to consider their cases for Review
Medical Examination.

The candidate will report to the Review Medical Board alongwith form 4, 5, and 6
duly completed in all respect and Bank Draft of Rs. 25/- for Review Medical Examination.
The Chairman Recruitment Board will intimate the date and time and place of Review
Medical Board where the candidate will have to appear for review medical examination.
The decision of the Review Medical Board of SSB will be final and no 2nd appeal
will be entertained as per Govt. instructions and also no reply of the correspondence /
2nd appeal will be given / entertained.
11.

FINAL SELECTION:-

The final selection list will be prepared in order of merit, category
wise, after completion of Review Medical Examination on the basis
of merit of written examination keeping in view the number of
vacancies available. It is hereby emphasized that the candidates
who merely secure the qualifying percentage marks and found
medically fit, may not be considered for final selection since the
cut off marks will be determined according to number of vacancies
as well as after completion of whole recruitment process. Where
equal marks have been obtained by candidates their merit will be fixed as per
date of birth. The older candidate will be given preference and in case the date
of birth is also the same, marks in the written test would decide the merit.

--::6::--

13.

NO TA/DA WILL BE ADMISSIBLE.

No TA/DA will be admissible. However, TA for onward and return journey to
SC/ ST candidates will be paid as per GOI instructions to those who appear in
written test subject to production of rail/ Bus tickets, original caste certificate,
non employment certificate from MP or MLA or any Gazetted Officer of the
locality, in case they are not employed in Central / State Government etc..
13.

i)

ii)

iii)

iv)
v)

General instructions:-

Applications submitted on a format, which is not the same, as published
in this advertisement, incomplete applications are liable to be rejected
summarily and no correspondence will be entertained in this regard.
If the above documents are not submitted along with the application, it
will be rejected summarily or at any stage of the recruitment process and
no request for reconsideration will be entertained.
Incomplete or unsigned applications, applications without
Photograph/attested photographs, will be rejected summarily.
All candidates in Govt. service whether in a permanent or in temporary
capacity etc. will be required to submit their application along with NOC.
Any wrong attestation so as to mislead the Recruitment board or to gain
access to examination would lead to criminal/debar action against the
candidate besides cancellation of candidature.

vi)

No separate admit cards/ call letters will be issued to the qualified
candidates called for written examination, and final medical
examination. The same will be apprised to the candidate by the
recruitment board and the list of qualified candidates called for
above test will be displayed on the notice board at the recruitment
venue as well as in SSB recruitment website www.ssbrectt.gov.in .

vii)

In case any candidate is found ineligible or suppressing facts or suffering
from any illness/ disease likely to interfere in efficient discharge of his
duties or on any ground after his selection/appointment, his services will
be terminated without assigning any reason.

viii)) The Government shall not be responsible for damage /injury/loss to the
individual, if any, sustained during the entire recruitment process and
journey.
ix)
x)

xi]

xii)

The DG SSB has full rights to make changes or cancel /postpone the
recruitment without assigning any reason.
Candidates canvassing in any form or bringing outside influence
/pressure, offering illegal gratification, blackmailing or threatening to
blackmail any person connected with recruitment will be disqualified.
Candidates indulging in illegal means, undesirable activities,
impersonating and submitting the fabricated/forged documents are also
liable to be disqualified.
It should, however, be clearly understood that the Selection board
reserves to itself, absolute discretion to reject or accept any
candidate at any stage.

--::7::--

xiii) Mere qualifying all the prescribed tests in SSB recruitment, does not
confer the right of selection of the candidate but they should have to
stand in merit keeping in view the available vacancies. The vacancies are
subject to change.
xiv) The candidates provisionally selected for the above posts should
qualify the training or courses as prescribed by the concerned
authorities of CAPFs from time to time during probation period.
Failing which services are liable to be terminated.
xv)

SSB strives to recruit fit, committed, talented, sincere and best candidates with
complete transparency and impartiality. Hence, candidates are advised to
BEWARE OF TOUTS.

ANNEXURE-A
GOVERNMENT OF INDIA, MINISTRY OF HOME AFFAIRS (SASHASTRA SEEMA BAL)

APPLICATION FORM FOR RALLY BASED RECRUITMENT OF BORDER DISTRICT OF BIHAR
STATEFOR THE POST OF CONSTABLE (GD)-2013
(I)
(II)

Paste a recent
Colour Photograph of
size 3.5 x 4.5Cms
with in the box only
duly attested by a

Please tick wherever relevant.
If others, specify.

(a) State code

0

5

Gazetted Officer

1.

Name in BLOCK LETTERS (as recorded in Matriculation Certificate)

FIRST NAME
MIDDLE
2.
Father’s name (as entered in Matriculation Certificate)

3
D

SURNAME

(a) Date of birth (as in Matriculation certificate) (b) Age as on 01-01-2013
D

M

M

Y

Y

1

9

Y

Y

Y

Y

M

M

D

4. Educational Qualification (Attach CTC of Edu. /Tech. Qualification certificate(s) etc.
Exam.
Name of School/Board/University/Institute
Subject Studied
Passed

5.
Hindu

Community/Religion:
Muslim
Sikh

Christian

Buddhist

Jain

D

Aggregate %

If others, specify

6. Category to which belongsSC

ST

OBC

(Attached certificate true copy as per Central Govt. instructions).
7.

Whether belonging to Domiciled ordly.in J&K during 198089

In the riots
1984

2002 communal riots of
Gujarat

(Attach certificate true copy).

8. Permanent address:

Police Station
Tehsil.
District
P
Contact No:

I
N
E-Mail ID.

9. Present address:

Police Station
Tehsil.
District
P
Contact No:

I
N
E-Mail ID.
Contd…2/-

-2-

10. Whether employed in SSB
If so, mention following details.
Name of present
Date since when
employer

13. Govt. Service

Post held

Nam e and designation of authority issuing
N.O.C.

11. IDENTIFICATION MARK (Please write in the box)

12..LEFT THUMB IMPRESSION OF THE CANDIDATE

(Unsigned application received if any will be rejected in Toto).
Strike out whichever is not applicable*.
NOTE: - Candidates should apply only if they fulfill all the physical standard &
advertisement to avoid any disappointment at later stage.

Educational

qualifications as m entioned in the

DECLARATION

I hereby declare that all statements made in this application are true and complete to the best of my knowledge and
belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the test and
interview, my candidature will stand cancelled and all my claims of the recruitment will stand forfeited.

SIGNATURE OF THE CANDIDATE

Annexure-‘B’
FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR
SCHEDULED TRIBE

This is to certify that Shri_________________________________ Son of Shri _____________
_______________________________of village/Town_______________________in District/ Division
_____________________ of the State/Union Territory _____________________ belongs to the
_____________ caste/Tribe which is recognized as a Schedule Caste/Scheduled Tribe under.
The Constitution (Scheduled Castes) order, 1950.
The Constitution (Scheduled Tribes) order, 1950.
The Constitution (Scheduled Castes)(Union Territory) order, 1951.
The Constitution (Scheduled Tribes) (Union Territory) order, 1951.
(As amended by the Scheduled Castes and Scheduled Tribes (Modification) Order 1956, the Bombay
Reorganization Act, 1960, the Punjab Reorganization Act, 1966, The State of Himachal Pradesh Act,
1970, the North Eastern Areas (Reorganization Act, 1971) and the Scheduled Castes and Scheduled
Tribes orders (Amendment) Act, 1976.)
*The constitution (Jammu & Kashmir) Scheduled Caste Order, 1956;
*The Constitution (Andaman and Nicobar Islands) Scheduled Tribes, 1959, as amended by the
Scheduled Castes and Scheduled Tribes orders (Amendment) Act. 1976;
*The Constitution ( Dadra and Nagar Haveli) Scheduled Castes Order 1962;
*The Constitution (Dadra & Nagar Haveli) Scheduled Tribes Order, 1962;
*The Constitution (Pondichery) Scheduled Castes Order, 1964;
*The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967;
*The Constitution (Goa, Daman & Dieu) Scheduled Castes Order, 1968;
*The Constitution (Goa, Daman & Dieu) Scheduled Tribes Order, 1968;
*The Constitution (Nagaland) Scheduled Tribes Order, 1970;
*The Constitution (Sikkim) Scheduled Castes Order, 1978;
*The Constitution (Sikkim) Scheduled Tribes Order, 1978;
*The Constitution (Scheduled Castes) Orders (Amendment) Act, 1990.
*The Constitution (Scheduled Tribes) Order, (Amendment) Ordinance, 1991.
*The Constitution (Scheduled Tribes) Order, (Second Amendment) Act, 1991.
The Constitution (Scheduled Tribes) Ordinance, 1996
*2. This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes Certificate issue to
Shri _____________________________________Father of Shri _________________________
______of village/town________________________ in District/Division _____________________ of the
State/UT _________________ _____________who belong to the ____________ caste/Tribe which is
recognized as a SC/ST in the State/Union Territory __________________________ issued by the
_______________________________ ( name of the prescribed issuing authority) vide their No.
______________________________________ dated _____________
or
Shri ____________
__________________ and or his/her family ordinarily reside(s) in Village/Town _____________of
____________ District/Division of the State/Union Territory of _______________.
Place______________
Date_______________

Signature______________
Designation ____________
(With seal of Office)
NOTE:- The terms ordinarily reside(s) used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1950.
LIST OF AUTHORITIES EMPOWERED TO ISSUE CASTE/TRIBE CERTIFICATE:

1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner /Additional
Deputy Commissioner/Dy. Collector/ 1st Class Stipendiary Magistrate/Sub Divisional
Magistrate/Extra Assistant Commissioner/ Taluka Magistrate/Executive Magistrate.
2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
3. Revenue Officers not below the rank of Tehsildar.
4. Sub-Divisional Officers of the area where the candidate and / or his/her family
resides.
NOTE: -ST candidates belonging to Tamil Nadu State should submit caste certificate only
from the Revenue Division Officer.

ANNEXURE-‘C’
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING
FOR APPOINTMENT TO POSTS UNDER THE CENTRAL GOVERNMENT OF INDIA.

(G. I. Dept. of Per.& Trg. O. M. No.36033/28/94-Estt.(Res).dated 2-7-1997)
This is to certify that ………………………… son of …………………. Village
…………………….. District/Division…………………….
In the ……………………
State…………………… belongs to the……………………….. Community, which is
recognized as a Backward Class under: –
* (i)
Government of India, Ministry of Welfare, Resolution, No.12011/68/93-BCC (C),
dated the 10th September, 1993, published in the Gazette of India, Extraordinary,
Part-I, Section-I, NO. 186, dated the 13th September, 1993.
*(ii)
Government of India, Ministry of Welfare, Resolution No.12011/9/94-BCC, dated the
19th October, 1994, published in the Gazette of India, Extraordinary, Part-I, Section,
No. 163 dated the 20th October, 1994.
*(iii)
Government of India, Ministry of Welfare, Resolution No.12011/7/95-BCC, dated the
24th May, 1995, published in the Gazette of India, Extraordinary, Part-I, Section I, No.
88, dated the 25th May, 1995.
*(iv)
Government of India, Ministry of Welfare, Resolution No.12011/44/96-BCC, dated
the 9th March, 1996, published in the Gazette of India, Extraordinary, Part-I, Section
I, No. 60, dated the 11th March, 1996.
*(v)
Government of India, Ministry of Welfare, Resolution No.12011/44/96-BCC, dated
the 6th December 1996, published in the Gazette of India, Extraordinary, Part-I,
Section I, No. 210, dated the 11th December 1996.
*(vi)
Government of India, Ministry of Welfare, Resolution No.12011/13/97-BCC, dated
the 3rd December, 1997, published in the Gazette of India, Extraordinary, Part-I,
Section I, No. 239, dated the 17th December, 1997.
*(vii)
Government of India, Ministry of Welfare, Resolution No.12011/99/94-BCC, dated
the 11th December 1997, published in the Gazette of India, Extraordinary, Part-I,
Section I, No. 236, dated the 12th December 1997.
*(viii)
Government of India, Ministry of Welfare, Resolution No.12011/68/98-BCC, dated
the 27 Oct., December, 1999, published in the Gazette of India, Extraordinary, Part-I,
Section I, No. 241, dated the 27th Oct, 1999.
*(ix)
Government of India, Ministry of Welfare, Resolution No.12011/88/98-BCC, dated
the 06th December 1999, published in the Gazette of India, Extraordinary, Part-I,
Section I, No. 270, dated the 06th December 1999.
*(x)
Government of India, Ministry of Welfare, Resolution No.12011/36/99-BCC, dated
the 4th April 2000, published in the Gazette of India, Extraordinary, Part-I, Section I,
No. 71, dated the 4th December 2000.
*(xi)
Government of India, Ministry of Welfare, Resolution No.12011/44/99-BCC, dated
the 21st December 2000, published in the Gazette of India, Extraordinary, Part-I,
Section I, No. 210, dated the 21st December 2000.
*(xii)
Government of India, Ministry of Welfare, Resolution No.12011/44/99-BCC, dated
the 6th September, 2001, published in the Gazette of India, Extraordinary, Part-I,
Section I, No.246, dated the 6th September, 2001
Shri……………………………………..and/or his family ordinarily reside(s) in the
……………………. District/ Division of the …………………………… State. This is also to
certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned
in Column 3 of the schedule to the Government of India, Department of Personnel, and
Training, O. M. No. 36012/22/93-Estt. (SCT), dated 8-9-1993.
DISTRICT MAGISTRATE/
DEPUTY COMMISSIONER/
TEHSILDAR ETC.

Dated:


OFFICE SEAL



Strike out which ever is not applicable
LIST OF AUTHORITIES EMPOWERED TO ISSUE CASTE/TRIBE CERTIFICATE:

1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner /Additional
Deputy Commissioner/Dy. Collector/ 1st Class Stipendiary Magistrate/Sub Divisional
Magistrate/Extra Assistant Commissioner/ Taluka Magistrate/Executive Magistrate.
2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
3. Revenue Officers not below the rank of Tehsildar/Naib Tehsildar
4. Sub-Divisional Officers of the area where the candidate and / or his/her family resides.

ANNEXURE-‘D’
QUESTIONNARIE FORM
1.

Have you ever been convicted by any court of law or any other judicial institution?

Yes/No

2.

Is there any case pending against you in any court of law?

Yes/No

3.

Has any FIR ever lodged and case is pending against you?

Yes/No

4.

Was any FIR ever lodged against you in the past?

Yes/No

a) If yes case No. and Section under which FIR was lodged?
b) Name of the Police Station where FIR was lodged?
c) Was the case charge sheeted or returned in FIR?
d) If the case charge sheeted, what was the outcome in court?
i) Convicted
ii) Acquitted
iii) Compromised
iv) Compounded
v) Any other, please specify
5.

Have you ever been dismissed from any service under the Central or State Govt.?

6.

Have your services ever been terminated while on probation?
If the answer to any of the above is YES then please provide complete details on a separate Sheet.

Undertaking

I,___________________________ declare that the above information is true to the best of my
knowledge and belief. I under stand that in case information is found to be false or incorrect my candidature
is liable to be cancelled apart from any departmental or legal proceedings that may be initiated against me.

Place:Date:-

Signature of Candidate
Name________________
Fathers Name ___________________
Address_________________________