Intimation Regarding Pre-Appointment Formalities for Assistant Section Officers’ Grade (Group B, Non-Gazetted) of Central Secretariat Service (CSS)

I

Successful candidates of the Combined Graduate Level Examination (CGLE) 2020 are being allocated to the Assistant Section Officers’ Grade of the Central Secretariat Service. Candidates are required to complete pre-appointment formalities, which involve pre-registration on an online portal and submission of necessary documents. Candidates residing in Delhi have additional requirements, including filling the Delhi Police Verification Form. All candidates undergo a medical examination to determine their fitness for government service, and must complete a compulsory foundation course at the Institute of Secretariat Training and Management (ISTM). The document emphasizes the importance of providing accurate information and the consequences of furnishing false certificates.

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F.No.7/20/2022-CS.I(A)
Government of India
Ministry of Personnel, Public Grievances \& Pensions
(Department of Personnel \& Training)
CS.I Division
$2^{\text {nd }}$ Floor, Lok Nayak Bhawan, Khan Market, New Delhi -110003. Dated $45^{\text {th }}$ November, 2022.

To
The Successful candidates of CGLE, 2020
Nominated to Assistant Section Officers’
Grade of CSS (as per Annexure-I)
Subject: Combined Graduate Level Examination, 2020 – Intimation regarding preappointment formalities for the post of Assistant Section Officers’ (ASO) Grade (Group B, Non-Gazetted) of Central Secretariat Service (CSS).

Dear Candidates,

Congratulations on your success in the Combined Graduate Level Examination, 2020!

I am directed to say that you have been allocated and nominated for appointment to Assistant Section Officers’ Grade of Central Secretariat Service by Staff Selection Commission on the basis of Combined Graduate Level Examination (CGLE), 2020 as per the list attached. The allocation has been made on the basis of your rank in the merit list, eligibility, preference for services expressed by you and availability of vacancy. Though utmost care has been taken while preparing the list annexed, yet you are advised to cross check the particulars pertaining to yourself with the result declared by SSC.
2. All the successful candidates nominated for the Assistant Section Officers’ Grade of CSS are pre-registered on the Online Portal https://doptapp.nic.in/CGLE/ASO. The candidates are required to fill-up/upload and submit the following documents online:
(i) Willingness to join the post.
(ii) Attestation Form (AF)
(iii) Medical Fitness Certificate
2.1 The candidates, who are presently residing in Delhi or those who indicate having resided in Delhi in the point number 10 of the AF should additionally fill the “Delhi Police Verification Form” given in the portal. The detailed guidelines for filling up/uploading of the aforesaid forms through the Portal are given in Annexure-II.
3. All the candidates residing outside Delhi are required to appear before the Civil Surgeon/Principal Medical Officer/Chief Medical Officer of the District where the candidates are presently residing, for medical examination, to determine their fitness for the Government service. The candidates are required to give a statement and declaration regarding his/her health in the attached form in the presence of Medical Officer. The medical certificate of fitness should be in the prescribed format, a specimen of which is attached (Annexure-III). The CMOs concerned are also requested to take up the Medical Examination of the candidates concerned on the strength of this letter. In case any other authority letter is required by the Office of medical authority concerned, the


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undersigned may be contacted through mail at cs1-a-dopt@gov.in. The candidates must send the Original Medical Certificate to the undersigned by speed post/registered post within the specified period.

3.1 Candidates presently residing in Delhi, as per the information furnished in their Application form submitted to SSC, will be informed about their medical examination through the online portal.

3.2 However, if the candidate is already in Government service, instead of obtaining a fresh medical report, they may produce this letter to their Controlling Authority to enable them to forward an attested copy of their medical examination report (with attested photograph) obtained at the time of the appointment, to the undersigned. The candidates must ensure that the said medical examination report furnished to the previous employer should have been issued by Civil Surgeon/Chief Medical Officer or equivalent.

3.3 Further, candidates residing outside Delhi who wish to get their medical examination conducted in Delhi, may opt for the same in the willingness form. However, it may be noted that no TA/DA will be provided by the Department in such cases. Further, they will have to undergo their Medical Examination on allotted date and time.

  1. Candidates should ensure that the requisite documents/information as sought vide paras above, are submitted/uploaded on the online portal latest by 05th December, 2022. In case of any query, candidates may contact the undersigned.

The Under Secretary CS.I (A)
CS.I Division,
Department of Personnel & Training,
2nd Floor, Lok Nayak Bhawan,
Khan Market, New Delhi-110003
Tel: 011-24642705
Email: cs1-a-dopt@gov.in

  1. It may also be noted that mere submission of willingness and other documents will not entitle any candidate to claim appointment to the post which will be subject to the fulfillment of stipulated terms and conditions.

  2. The eligibility of candidates shall be determined for consideration for appointment based on the information furnished in the attestation form. If found eligible, candidates will be offered appointment to the post of Assistant Section Officer in Central Secretariat Service subject to the verification of character and antecedents/claim for EWS/OBC (Non-creamy layer)/SC/ST/PwBD status. The formal offer of appointment will be sent to you separately by this Department. Alongwith the offer of appointment, the candidates will be intimated about the Ministry/Department to which they are being posted.

  3. The candidates will have to undergo the foundation course organized by the Institute of Secretariat Training and Management (ISTM) or any other Institute(s) nominated for this purpose, as and when organized. The Foundation Course is compulsory and has to be completed as a part of the successful completion of probation in service.

  4. The candidates must note that in case, at any stage, it is found that the candidate’s certificate is fake or candidate has furnished false information, he/she shall be liable to be proceeded against, under the relevant rules, leading to such penalty as may be decided, which now extends to the

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termination of his/her appointment. Such action shall also be without prejudice to any other punitive action as may be attracted in such cases.

  1. Attention is also invited to this Department’s OM No. 11012/7/91-Estt.(A) dated 19.05.1993 as amended from time to time which already stipulates the action that can follow on furnishing of false information or submission of false certificates. The operative part of the said OM is reproduced below:-

“Wherever it is found that a candidate who was not qualified or eligible in terms of the recruitment rules etc. for initial recruitment in service or had furnished false information or produced a false certificate in order to secure appointment, he should not be retained in service. If, he is probationer or a temporary Government servant, he should be discharged or his services should be terminated. If he has become a permanent Government servant, an enquiry as prescribed in Rule 14 of CCS (CCA) Rules, 1965 may be held and if the charges are proved, the Government servant should be removed or dismissed from service. In no circumstances should any other penalty be imposed”

  1. The offer of appointment when made, will be provisional for the candidates who have claimed/availed the benefits of any type of reservation for posts and service in terms of the following instructions as may be relevant to them:-

(i) EWS Candidates:- The appointment is provisional and is subject to the due verification of Income and asset certificate by DoP&T

(ii) SC/ST Candidates: – The appointment will be provisional and is subject to due verification of SC/ST certificate by DoP&T.

(iii) OBC Candidates:- This Department has issued OM No. 36012/22/93-Estt.(SCT) dated 8th September, 1993; OM No. 36033/3/2004-Estt.(Res) dated 14th October, 2008 and other extant instructions in this regard from time to time. In accordance with these instructions, only Non-Creamy Layer OBC candidates are entitled to get the benefits of reservations earmarked for Other Backward Classes (OBC). The allocation is, therefore, provisional to this extent and is subject to further verification of OBC certificate by DoP&T

(iv) PwBD Candidates:- The appointment will be provisional and subject to due verification of concerned certificate by DoP&T.

Yours faithfully,

(George D. Toppo)

Under Secretary to the Government of India

Tel: 24642705

NOTE: 1. Candidates may please note that further updates/information in regard to appointment to the post of ASO on the basis of CGLE-2020 will be placed only on the website of DoP&T (www.dopt.gov.in-What’s new) and also www.dopt.gov.in – About us – Central Secretariat — Central Secretariat Service – Recruitment (DR Assistants). They are, therefore, advised to regularly visit DoP&T’s website for any updates.

  1. Candidates should indicate their All India Rank of CGLE 2020 in all their correspondence with this Department, including in the subject of email.

Annexure I

| SNO. | SALUTATION | NAME | RANK | DOB |
| — | — | — | — | — |
| 1 | MS. | NISHA | 5 | 17-09-94 |
| 2 | SHRI | SAKET KUMAR SINGH | 28 | 22-04-98 |
| 3 | MS. | MANISHA VASHISHTHA | 32 | 02-03-99 |
| 4 | SHRI | ABHIK PATLA | 55 | 28-04-98 |
| 5 | SHRI | PRATYUSH JAIN | 56 | 08-10-95 |
| 6 | SHRI | ADITYA | 68 | 16-12-98 |
| 7 | SHRI | RAHUL SRIVASTAVA | 75 | 21-08-00 |
| 8 | SHRI | DHEERAI SANWAL | 78 | 18-11-94 |
| 9 | MS. | ALKA RAWAT | 80 | 10-02-96 |
| 10 | SHRI | RISHABH DWIVEDI | 84 | 30-06-95 |
| 11 | SHRI | AMIT NAWANI | 85 | 16-11-99 |
| 12 | SHRI | ABHISHEK KUMAR | 91 | 01-03-97 |
| 13 | SHRI | VIVIDH DOBHAL | 92 | 27-12-99 |
| 14 | SHRI | ANKIT ANAND | 94 | 20-12-96 |
| 15 | SHRI | ANKUSH CHHILLAR | 101 | 01-07-97 |
| 16 | MS. | ANJU BHARDWAJ | 106 | 18-11-92 |
| 17 | SHRI | SACHIN KHATRI | 107 | 16-03-00 |
| 18 | SHRI | GAURAV GUPTA | 111 | 16-11-96 |
| 19 | SHRI | PRABHAT KUMAR | 113 | 02-03-93 |
| 20 | SHRI | VIJAY KUMAR | 116 | 10-06-97 |
| 21 | SHRI | JITENDER | 118 | 27-12-99 |
| 22 | SHRI | RISHAV KUMAR PANDEY | 126 | 21-11-96 |
| 23 | SHRI | PINTU KUMAR SINGH | 127 | 30-09-96 |
| 24 | SHRI | KRISHAN | 130 | 04-03-93 |
| 25 | SHRI | ANAND KUMAR KAMDAR | 131 | 08-05-97 |
| 26 | SHRI | PRAWIN BARANWAL | 132 | 06-12-97 |
| 27 | SHRI | CHETAN KUMAR | 139 | 12-03-97 |
| 28 | SHRI | HITESH GHUGTYAL | 141 | 21-02-97 |
| 29 | SHRI | ABHISHEK MISHRA | 145 | 17-09-95 |
| 30 | SHRI | RITIK MALIK | 147 | 22-04-98 |
| 31 | SHRI | ABHISHEK GUPTA | 150 | 07-08-96 |
| 32 | SHRI | YASH PANDEY | 151 | 11-12-99 |
| 33 | SHRI | SAUBHAGYA SINGH | 152 | 25-07-96 |
| 34 | SHRI | MANISH RAWAT | 155 | 12-09-94 |
| 35 | SHRI | VISHAL CHOUDHARY | 161 | 07-11-94 |
| 36 | MS. | SMRITI KUMARI | 162 | 20-08-96 |
| 37 | SHRI | SABJEET KUMAR SINGH | 177 | 25-05-91 |
| 38 | SHRI | UJJWAL BANSAL | 178 | 17-08-98 |
| 39 | SHRI | SHIV PRATAP SINGH
RATHORE | 179 | 15-10-98 |
| 40 | SHRI | VARUN SHARMA | 182 | 28-11-98 |
| 41 | MS. | RASHMI | 183 | 11-02-99 |
| 42 | MS. | PREETI JAGLAN | 189 | 04-05-98 |
| 43 | SHRI | SHIVAM TOMAR | 194 | 03-01-00 |
| 44 | SHRI | NEERAI KUMAR GUPTA | 196 | 24-03-00 |

| SNO. | SALUTATION | NAME | RANK | DOB |
| — | — | — | — | — |
| 45 | SHRI | CHETAN PANDEY | 198 | 21-01-96 |
| 46 | SHRI | RISHABH KOHLI | 199 | 21-01-98 |
| 47 | SHRI | SOURABH SHARMA | 200 | 25-12-95 |
| 48 | SHRI | SAURABH PANT | 201 | 03-03-00 |
| 49 | SHRI | RAJ KUMAR | 205 | 22-12-96 |
| 50 | SHRI | CHUNESH KUMAR | 214 | 06-10-98 |
| 51 | SHRI | HIMANSHU JAIN | 219 | 30-09-94 |
| 52 | SHRI | YASH JAIN | 224 | 18-04-98 |
| 53 | SHRI | PRATEEK GARG | 225 | 29-10-99 |
| 54 | SHRI | UTKARSH SRIVASTAVA | 227 | 11-02-94 |
| 55 | MS. | SONALI ACHARYA | 236 | 26-01-93 |
| 56 | SHRI | MOHIT SHARMA | 237 | 15-09-96 |
| 57 | MS. | SHRADHA AGRAWAL | 238 | 21-11-99 |
| 58 | SHRI | ASHUTOSH SINGH | 239 | 01-07-97 |
| 59 | SHRI | RAMESHWAR | 240 | 29-06-94 |
| 60 | SHRI | HARSHIT MANARAL | 246 | 27-02-99 |
| 61 | SHRI | RAJEEV RANJAN | 249 | 06-03-99 |
| 62 | SHRI | HARSH GUPTA | 260 | 04-07-98 |
| 63 | SHRI | GYANENDRA KUMAR
SHARMA | 268 | 15-02-00 |
| 64 | SHRI | ANSHUL SHARMA | 278 | 01-11-97 |
| 65 | SHRI | AMIT SINGH | 282 | 12-03-97 |
| 66 | SHRI | ROHAN TOMER | 295 | 19-10-98 |
| 67 | SHRI | DEVENDRA SINGH | 302 | 21-09-98 |
| 68 | SHRI | DEEPAK KUMAR SINGH | 318 | 05-09-97 |
| 69 | MS. | SHRUTI GOYAL | 320 | 29-11-99 |
| 70 | SHRI | VIVEK BHINCHAR | 321 | 07-01-97 |
| 71 | MS. | BHAWNA BHARTI | 332 | 05-08-00 |
| 72 | SHRI | PUSHP RAJ | 345 | 04-02-98 |
| 73 | SHRI | UTKARSH SRIVASTAVA | 359 | 17-06-94 |
| 74 | MS. | MOSAM | 365 | 18-08-94 |
| 75 | SHRI | GAGAN TOMAR | 381 | 03-10-99 |
| 76 | SHRI | PARAS YADAV | 385 | 29-06-99 |
| 77 | SHRI | HARSHIT SRIVASTAVA | 393 | 27-02-96 |
| 78 | SHRI | ANMOL MISHRA | 396 | 18-02-97 |
| 79 | SHRI | PRANJAL RAJ | 407 | 03-11-93 |
| 80 | MS. | RUPALI SONI | 413 | 10-11-99 |
| 81 | SHRI | SONU RAY | 456 | 29-11-98 |
| 82 | SHRI | SUMIT TAK | 457 | 03-04-97 |
| 83 | SHRI | PRATEEK YADAV | 486 | 06-12-96 |
| 84 | SHRI | BHUPENDRA CHOUDHARY | 488 | 05-06-97 |
| 85 | SHRI | ADITYA SIDDHARTH SINGH | 497 | 23-05-00 |
| 86 | SHRI | VIRENDRA SINGH | 543 | 05-06-98 |
| 87 | SHRI | SHIVAM VERMA | 545 | 18-07-98 |
| 88 | SHRI | ABHISHEK RAJ | 557 | 10-01-98 |


SNO. SALUTATION NAME RANK DOB
89 SHRI SURAJ KUMAR 559 19-11-95
90 SHRI MOHIT KUMAWAT 568 17-01-99
91 SHRI GANESH KUMAR 574 06-03-99
92 SHRI RAM MILAN RAJPOOT 591 02-08-95
93 SHRI SHUBHAM SINGH 594 25-01-98
94 SHRI ANISH KUMAR 601 18-12-00
95 SHRI JAGBEER 635 25-06-94
96 SHRI RAJRATAN YADAV 646 22-04-97
97 SHRI TARUN KUMAR 649 02-12-93
98 SHRI SURAJ KUMAR YADAV 655 05-07-98
99 SHRI AJAY 662 07-08-98
100 SHRI VIVEK YADAV 677 08-10-98
101 SHRI BADSHAH BAWA 679 10-02-96
102 SHRI SHIVAM KUMAR SHAW 686 08-02-00
103 SHRI MANAV RAJNISH 690 22-10-99
104 MS. SUSMITA SHARMA 696 19-06-98
105 SHRI ANKUR KUMAR 698 16-06-97
106 SHRI PRADEEP KUMAR 709 25-06-98
107 SHRI KAPIL TAILOR 726 11-07-96
108 SHRI MUKAT BIHARI 727 06-01-99
109 SHRI CHANDAN KUMAR 728 15-01-96
110 SHRI RAJAT YADAV 729 06-03-99
111 SHRI RAHUL 746 08-06-99
112 MS. LEKHA SAINI 751 28-06-00
113 MS. ANJALI 753 20-12-99
114 SHRI RAVI GUPTA 773 17-09-96
115 SHRI MUKUL KUMAR SINGH 786 26-04-98
116 MS. SHIVANI SAHU 801 10-05-99
117 SHRI RAJEEV SINGH YADAV 802 14-06-98
118 SHRI KAMLESH KUMAWAT 809 03-01-98
119 MS. RITIKA KUMARI 812 15-11-97
120 SHRI SHASHI KAMAL 817 16-06-97
SNO. SALUTATION NAME RANK DOB
121 SHRI LOVELY YADAV 818 25-07-97
122 MS. MAHIMA VERMA 824 23-08-98
123 SHRI RAKESH KUMAWAT 835 17-11-00
124 SHRI NITESH KUMAR PRASAD 843 15-03-96
125 SHRI ABHISHEK SHARMA 1290 10-12-98
126 SHRI BHATT DEEP PARESHKUMAR 1482 15-08-95
127 SHRI RAJESH KUMAR 2224 01-02-98
128 MS. NIDHI 2239 23-09-95
129 SHRI ANKIT SHARMA 2298 10-04-93
130 MS. KARUNA BARAD 2318 25-12-96
131 SHRI KISHAN KUMAR 2386 02-04-97
132 SHRI SACHIN KUMAR 2599 28-03-96
133 SHRI ANSHUL KUMAR 2748 12-10-97
134 SHRI MEHUL KUMAR 2903 09-07-97
135 SHRI NEERAJ KUMAR ARYA 2912 21-06-90
136 SHRI DUSHYANT 2952 06-07-96
137 SHRI SHIVAM RAI 3371 29-09-98
138 SHRI SATYAM RAJ 3541 04-11-96
139 SHRI AJAY KUMAR MEENA 3840 10-11-97
140 SHRI RAHUL KUMAR MEENA 3984 15-06-99
141 SHRI RINKU KUMAR MEENA 4109 13-07-98
142 MS. SUNITA KUMARI MEENA 4214 15-08-97
143 SHRI ABHISHEK MEENA 4359 12-11-00
144 SHRI MUKESH KUMAR MEENA 4375 06-02-00
145 SHRI KAMLESH MEENA 4403 05-07-94
146 SHRI SANDEEP THAKUR 4623 29-09-93
147 SHRI AVNISH JAREDA 4643 23-01-99
148 MS. HARIPRIYA BARA 4648 02-05-97
149 SHRI JATIN JAIN 4778 21-10-96
150 SHRI DAL CHAND SHARMA 6096 24-06-93
151 SHRI VINEET KUMAR 6275 01-07-96

Annexure-II

Guidelines for completion of pre-appointment formalities to the post of ASO in CSS selected on the basis of CGLE-2020 on Online Portal (https://doptapp.nic.in/CGLE/ASO).

Note: Candidates are advised to read the following instructions before completion of pre-appointment formalities and should keep the soft copies of the following handy:

  • Passport size photograph (max 50KB/JPG format)
  • Signature (max 20KB/JPG format)
  • Photo Identity [PAN/VoterID/Driving Licence/Aadhaar] (max 100KB/JPG or PDF format)
  • Address Proof [Passport/Telephone/Electricity/PNG bill/Aadhaar Card/Voter ID/Bank Passbook/Rent Agreement] (max 100KB/JPG or PDF format)
  1. It may be noted that candidates who have been selected for the post of ASO in CSS on the basis of CGLE-2020 are pre-registered with basic details (like-Name, Roll No. Rank, Category, DoB, Mobile Number, e-mail id) on the Online Portal.

  2. Candidate should click on FORGOT password to create a new password through their e-Mail id and mobile number furnished to SSC while applying for the post.

SOC-CGLE CCGLE
Comblined Graduate Level Examinations SSC-Examinations
SSC SSC
Log In
E-mail
Password

iii) Delhi Police Verification Format – This Police Verification form will be available to those candidates who have declared themselves as resident of Delhi in the willingness form and/or have filled a Delhi address in the residential history of the Attestation Form.

iv) Medical Certificate –

a) Candidates outside Delhi have to upload the scanned copy of their Medical Examination Report as provided to them by the Civil Surgeon/Principal Medical Officer/Chief Medical Officer of the District concerned.
b) The Medical examination of the candidates residing in Delhi and those who reside outside Delhi \& wish to get their medical examination conducted in Delhi, will be conducted at designated Hospitals on a specific date and time. Their medical reports will be uploaded by this Department.
c) The medical report of the candidates who are already employed in Government Service, will also be uploaded by this Department as and when the attested copy of the same is received from their previous employer. These candidates may also opt to undergo fresh medical examination and upload the report on the portal.
d) All the candidates may submit their willingness \& Attestation Form as soon as possible to enable this Department to get the Medical Examination completed in a timely manner at designated hospitals.
5. Candidates are required to fill in and save each module completely before finally submitting the form online. Candidates will have the option to make changes in any module only before final submission of attestation form. Once final submission has been made, no change will be possible online.
6. Candidates may note that some of the fields namely Candidate’s name, Date of Birth, Category, Category selected, e-mail address, PwBDs, etc. have been pre-populated using the information provided by the candidate at the time of filling up the earlier Online Application Form for CGLE-2020. Such fields cannot be changed by the candidate. However, if a candidate notes any error/discrepancy in these fields, he may make a separate detailed representation to this office including all relevant documents in support of his/her claim at cs1-a-dopt@gov.in . This office will decide each such case on merit and its decision in such cases shall be final.
7. If any candidate presently does not have access to the mobile number furnished at the time of application, may send an email to cs1-a-dopt@gov.in citing the old mobile number and the new number, along with the reason.
8. For any queries related to Online Portal, you may contact on the e-Mail id of the Helpdesk cs1-a-dopt@gov.in constituted for the purpose. The candidates must mention the subject of the e-Mail as “CGLE-2020-Name-Rank”.


FORM OF MEDICAL CERTIFICATE

I hereby certify that I have examined $\mathrm{Sh} / \mathrm{Smt} / \mathrm{Km}$.
a candidate for employment in the Central Secretariat Service in the Government of India and cannot discover that he/she has any disease (communicable or otherwise), constitutional weakness or bodily infirmity, except $\qquad$ .

I do not consider this a disqualification for employment in Central Secretariat Service in the Government of India.
The age of Shri/Smt./Kum. $\qquad$ according to his/her own statement is $\qquad$ years, and by appearance is about $\qquad$ years.
(Signature/thumb impression of the candidate)

Date $\qquad$
(To be signed in the presence of the examining Medical Officer)
img-0.jpeg

Signature of Medical Officer
Name $\qquad$
Address $\qquad$
Official Seal
(Seal should be spread over form and the photograph)

Note: The officer making this certificate should be a Civil Surgeon or a District Medical Officer of equivalent status of a Government Hospital


CANDIDATE’S STATEMENT AND DECLARATION

(The candidate must make the following statement and must sign the declaration below it before the medical officer. Attention is specially invited to the WARNING in the ‘Note’ at the bottom of page 2.)

  1. Name in full (in BLOCK letters)
  2. Age and place of birth
  3. Have you ever had (a)small-pox, intermittent fever and other fever, enlargement suppuration of glands, spitting of blood, fainting attacks, rheumatism or appendicitis? OR (b) any other disease or accident requiring confinement to bed and medical or surgical treatment?
  4. When were you last vaccinated?
  5. Have you or any of your relatives been afflicted by consumption, scrofula, gout, asthma, fits, epilepsy or insanity?
  6. Have you suffered from any form of nervousness due to overwork or any other cause?
  7. Have you been examined and declared fit for Govt. Service by a medical officer/ Medical Board within the last three years?
  8. Furnish the following particulars:
Father’s age, if living, \& state of health Father’s age at the time of death and cause of death No. of brothers living, their ages and state of health No. of brothers who have died, their ages at death and cause of death

Mother’s age, if living, \& state of health Mother’s age at the time of death and cause of death No. of sisters living, their ages and state of health No. of sisters who have died, their ages at death and cause of death

DECLARATION

I declare that all the above answers are true and correct to the best of my knowledge and belief. I also solemnly affirm that I have not received any disability certificate/ pension on account of any disease or other condition.

Candidate’s signature

Date: $\qquad$
Signed in my presence.

Signature of Medical Officer
Name: $\qquad$
\& Designation: $\qquad$

Note: The candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing any information he will incur the risk of losing the appointment and, if appointed, of forfeiting all claims to superannuation allowance or gratuity.
(Please take back to back print)