CERTIFICATE OF PHYSICAL FITNESS

Name, Rank and Medical Qualifications

of an Officer Granting the Certificate with
Register Number.

I do hereby certify that I have examined (full name___________________________________) a

candidate for employment under the Telangana State Power Generation Corporation Limited, in the O&M

service as _____________________________ and cannot discover that he has any disease, constitutional

affection or bodily infirmity except that his weight is in excess of/below the standard prescribed, or except

I do/do not consider this a disqualification for the employment he seeks.

I do further certify that in my opinion his general physical condition is such as to enable him to

perform efficiently the active duties of executive service.

I also certify that he has marks of Small Pox/Vaccination.

Chest Measurement in centimeters in full inspiration/on full expiration/difference (Expansion).

Weight Height Meters Centimeters.

(in kgs)

His Visional
Is Normal

Hypermetropic ( )

(Here enter the degree of defect and the strength of correction of glasses).

Myopic ( )

(Here enter the degree of defect and the strength of correction of glasses).

Astigmatic (simple or mixed) ( )

(Here enter the degree of defect and the strength of correction of glasses).

Hearing is normal/defective (Much or slight).

Urine-Does chemical examination show(1) albumen, (2) Sugar, if so state specific gravity.

Personal Marks (atleast two should be mentioned)

i)

ii)

Signature
Rank/Qualification:
Station: Designation:
Date:
 :: 2 ::

The candidate must make the statement required below prior to his medical examination and must sign
the declaration, appended thereto. His attention is specially directed to the warning contained in the note
below.

1. State your name in full:

2. State your age and birth place:
3. a) Have you ever had small pox, intermittent or
any other fever, enlargement or suppuration
of glands splitting of blood, asthama,
inflammation of lungs, heart disease,
fainting attacks, rheumatism, appendicitis?

OR
b) Any other disease or accident requiring confinement to bend and medical or surgical
treatments?

c) Suffered from any illness, wound or injuries sustained while on active services during the
war.

4. When were you last vaccinated?

5. Have you or any of your near relations been afflicted with consumption, scrofula, gout,
asthama, fits, epilepsy or insanity?
6. Have you suffered from any form of nervousness due to over work or any other cause?
7. Have you been examined and declared unfit for Government or GENCO service by any
Medical Officer/Medical board within the last three years?
(To be filled in only in the case of candidate under Class-III and Class-IV of any service under
GENCO)

8. Furnish the following particulars concerning your family.

Father’s age if living Father’s age at death & No. of brothers No. of brothers dead,
and state of health cause of death living, their ages & their ages and cause of
State of health death.

Mother’s age if living Mother’s age at death No. of sisters living, No. of sisters dead,
and state of health & cause of death their ages & State of their ages and cause of
health death.

I declare that all the above answers are true and correct to the best of my knowledge.

CANDIDATE`S SIGNATURE
NOTE: The candidate will be held responsible for the accuracy of the above statement. By willfully
suppressing any information he/she will incur the risk of losing the appointment and if appointed for
forfeiting all claims to superannuation allowance or gratuity.
 BOND

Known all men by these presents that we (1) principal

Debtor__________________________________________________________________________

S/o, D/o.________________________________________________________________________

(Status of Parent)_________________________________________________________________

Resident at ______________________________________________________________________

in the District of _________________________________________________________________

in the Mandal of _______________________________________________________________

(2)

(1st Surety) Son of ________________________________________________________________

S
I Residing at ____________________________________________________________________ in S
G I
N the District of _______________________________________________________________ in the G
A N
T Mandal of _______________________________________________________________ A
U T
R (3) U
E R
(2nd Surety) Son of _____________________________________________________________ E
of
C of
Residing at _____________________________________________________________________ C
A
N A
in the District of _________________________________________________________________ N
D
I D
in the Mandal of __________________________________________________________________ I
D
A D
bind ourselves jointly and severally to the Telangana State Power Generation Corporation Limited
T A
(hereinafter referred to as the TSGENCO) which expression shall, where the context so admits
E T
include its successors for payment of (i) Rs.50,000/- plus stipend received or (ii) Rs.1,00,000/- as
E
the case may be by way of liquidated damages to the TSGENCO.

Signed by us this the _________________________ day of ___________________ 2016

Signatures: 1. (Debtor)

2. (1st Surety)

3. (IInd Surety)

Witness: 1.

2.

Whereas the above (1) ______________________________________________ (Principal

Debtor) is appointed as _______________________________________________ in the

Telangana State Power Generation Corporation Limited Services.

S I GNATURE of CANDIDATE
 2. And whereas it has been agreed that the above bounden

(1) _______________________________________________________________________ shall

enter into a service bond for the above-mentioned sum with such conditions as hereunder written

with the above bounden.

(2) _______________________________________________________________________ and

above bounden

(3) _____________________________________________________________ as sureties.

3. Now the conditions of the above written bond are such that (i) if for any reason other than
death or disability or other causes acceptable to the TSGENCO, the bounden leaves the
Corporation during the period of training he/she shall refund to the TSGENCO the amount of
stipend received by him/her plus Rs.50,000/- (Rupees fifty thousand only) by way of liquidated
damages within one month of demand (ii) The above bounden (1)
S S
_________________________________ shall serve the TSGENCO for a full period of five years
I I
G after successful completion of training and shall during such period of service abide by all the G
N Rules and Regulations as will be applicable to him/her. If for any reason other than death or N
A A
T disability or other causes acceptable to the corporation, the Bounden fails to serve the TSGENCO T
U for atleast five years he/she shall pay the TSGENCO by way of liquidated damages a sum of U
R R
E Rs.1,00,000/- (Rupees one lakh only) within one month of demand. Unless the said bounden (1) E
of ______________________ is prevented by accident or ill-health certified by a competent medical of
C C
authority for serving the TSGENCO at least for a period of five years, or the above bounden
A A
N (1)______________________________________________________________________ is N
D D
removed from service for any misconduct before the expiry of the said period of five years, or shall
I I
D for reasons acceptable to the appointing authority that he/she is unable to comply with all or any D
A of the terms and conditions of employment above named. The above bounden (1) A
T T
E _____________________________________ and or E
st
(2)_______________________________________________ (1 Surety) and or
nd
(3)_______________________________________________ (2 Surety) shall at all times within
thirty days of the receipt of notice in writing from the appointing authority pay all sums of money
that may become payable or refundable to the TSGENCO by the above bounden under any by
virtue of the above conditions of the bond.

4. Provided that any forgiveness or forbearance on the part of the TSGENCO towards the above
bounden in respect of his/her failure or neglect to perform such services and duties or any
forbearance or indulgence shown by the said TSGENCO whether as to payment, time for
performance or otherwise shall not any way release or exonerate the sureties or either of them,
their or either of their executors or administrators in respect of their or his/her liability under the
above written bond.

S I GNATURE of CANDIDATE
 5. And the TSGENCO without prejudice to any other rights may recover such sum or sums of
money as may be due from the above bounden (1)____________________________________
(2)______________________________________ (3)____________________________________
by virtue of this bond, as were arrears of land revenue under the act pertaining to the recovery of
land revenue inforce.

Signed by the above bounden (1)

(a) Postal Address :

(b) Permanent Address :

Signed by the 1st Surety (2)

With postal address

Official Designation :

S Official Address :
I (if he/she is an employee of S
G the State/Central Govt.,/
I
N Corporation etc.,)
G
A N
T Permanent Address :
A
U T
R U
E Signed by the 2nd Surety (3) R
of With postal address E
C of
A C
N Official Designation : A
D N
I Official Address :
D
D (if he/she is an employee of
I
A the State/Central Govt.,/
D
T Corporation etc.,)
A
E T
Permanent Address :
E

Witness:
(and their address in full)

(1)

(2)

NOTE: The Sureties must be:

i. Persons working in Central/State/Quasi Governments/Under-takings with a minimum of

8 years of service left with their employers. (Service Certificate from the employer with
his/her Date of Birth shall be enclosed )
(OR)

ii. Persons holding encumbered immovable property worth about Rs.1.00 Lakh and above
on production of encumbrance certificate and property valuation certificate from office
of the M.R.O. where the property is situated (necessary certificate from the concerned
Tahsildar Shall be enclosed.)

SIGNATURE of CANDIDATE
 FORMAT – I

UNDERTAKING

I, ________________________________________________________,

as per Notification No.2/CGM(Adm)/2018, Dt.13.04.2018, appointed as Junior

Accounts Officer in Telangana State Power Generation Corporation Limited

undertake that, I abide by the Rules and Regulations applicable or as framed

by the Telangana State Power Generation Corporation Limited and as amended

from time to time, that the Tripartite Agreements entered into between APSEB,

Government of T.S, and the APSEB Employees Associations are not applicable

to me as such agreement was entered into when I was neither an employee of

erstwhile APSEB/Composite APGENCO nor a member of any Employees

Association and hence that I shall at no stage be entitled to claim any right

whatsoever arising out of the said Tripartite Agreement.

SIGNATURE OF THE CANDIDATE

 A N N E X U R E – II

FORM – VII B

Serial No. District Code:

BC – A/B/C/D/E Emblem Mandal Code:

Certificate No. Village Code :

Creamy Layer/Non-Creamy Layer Certificate for

Backward Classes Groups – A, B, C, D & E applying for appointments to
Civil Posts and Services within the State of Telangana.

*******

This is to certify that Shri/Smt/Kumari ______________________________________

Son/Daughter of ____________________________________________ Village/Town __________

Door No. ____________________ Street Name ________________________ in the ____________

Talukar in _______________ Mandal ___________ in the Telangana State belong to _______

community ______________________ Religion which is recognized as a Backward Class

under Group _________ at Sl.No. _____ in the State of Telangana Vide G.O.Ms.No.34, BC

Welfare (OP), Dept., Dt.08.10.2015. This is also to certify that he/she does/does not

belong to persons/sections (Creamy Layer) Mentioned in Column – 3 of the Scheduled to

the Government of India, Department of Personnel & Training O.M.No.36012/22/93–

Estt. (SCT), Dtd.08.09.1993, adapted by Government of Telangana Vide G.O.Ms.No.20,

BC Welfare (OP) Dept., Dtd.31.10.2017.

ISSUING AUTHORITY*

Signature:

(Seal) Date:

Name in Capital Letters:

Designation:

* All the Revenue Officials in the State of Telangana not below the rank of Tahsildars.