ANNEXURE-E

Form of Certificate for serving Defence Personnel

(Please see Explanation II of Point-13 (thirteen) of Reservations and Relaxations of the Notice)

I hereby certify that, according to the information available with me (No.) ______________________
(Rank) ___________________ (Name) __________________________ is due to complete the specified
term of his engagement with the Armed Forces on the (Date) _______________________.

Place:
(Signature of Commanding Officer)

Date: Office Seal: ………………………………..

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 ANNEXURE-F

UNDERTAKING TO BE GIVEN BY THE CANDIDATE COVERED UNDER POINT-13 OF RESERVATIONS

AND RELAXATIONS OF THE NOTICE

I understand that, if selected on the basis of recruitment/examination to which the application relates,
my appointment will be subject to my producing documentary evidence to the satisfaction of the Appointing
Authority that I have been duly released/retired/discharged from the Armed Forces and that I am entitled
to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen (Re-Employment in Central Civil
Services and Posts rules, 1979, as amended from time to time).

I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-Servicemen in
regard to the recruitment covered by this examination, if I have at any time prior to such appointment, secured
any employment on the civil side (including Public Sector Undertaking, Autonomous Bodies/Statutory Bodies,
Nationalized Banks, etc.) by availing of the concession of reservation of vacancies admissible to Ex-Servicemen.

I further submit the following information:

a) Date of appointment in Armed Forces __________________

b) Date of discharge __________________

c) Length of service in Armed Forces __________________

d) My last Unit/Corps __________________

Place:

Date: (Signature of the Candidate)

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 ANNEXURE-G

Certificate regarding physical limitation of an examinee to write

This is to certify that, I have examined Mr/Ms/Mrs _____________________________________ (name of the

candidate with disability), a person with _______________________________________ (nature and percentage of
disability as with mentioned in the certificate of disability), S/o/D/o ______________________________, a resident of
_______________________ (Village/ District/State) and to state that he/she has physical limitation which hampers
his/her writing capabilities owing to his/her disability.

Signature

Chief Medical Officer/ Civil Surgeon/ Medical Superintendent of a

Government health care institution

Name & Designation.

Name of Government Hospital/ Health Care Centre with Seal

Place:

Date:

Note:

Certificate should be given by a specialist of the relevant stream/ disability (eg. Visual impairment - Ophthalmologist,
Locomotor disability - Orthopaedic specialist/PMR).

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 ANNEXURE-H
DECLARATION
We, the undersigned, Shri/Smt/Kum. ________________________________________________ eligible candidate
having qualification _______________________________ and Shri/Smt./Kum.
________________________________________________eligible writer (Scribe) having qualification
_______________________________ for the eligible candidate, do hereby declare that:
1. The scribe is identified by the candidate at his/her own cost and as per own choice.
2. In case it is found that the qualification of the Scribe is not as declared by the candidate and the qualification of the
Scribe is not one step below the qualification of the candidate taking examination, his/her candidature shall liable to
be summarily rejected. In such case the candidate shall forfeit his/her right to the post and claims relating thereto.
3. The candidate is a person with benchmark disabilities in the category of blindness, loco-motor disability (both arms
affected-BA) and cerebral palsy.
4. In case of other category of persons with benchmark disabilities, the candidate can be allowed the provisions of the
scribe provided that at the time of document verification, he/she has to produce the requisite certificate issued by
Chief Medical Officer/Civil Surgeon/Medical Superintendent of a Government health care institution in the prescribed
proforma (Annexure-G) to the effect that I have physical limitation to write, and scribe is essential to write examination
on my behalf, as per the provisions of Ministry of Social Justice & Empowerment O.M. No. 34-02/2015-DD-III dated
29th August, 2018.
5. As per the rules, the candidate availing services of a scribe is eligible for compensatory time of 20 minutes for every
hour of the examination.
6. In view of the importance of the time element and the examination being of a competitive nature, the candidate
undertakes to fully satisfy the Medical Officer of the Organization that there was necessity for use of a scribe as his/her
writing speed is affected by the disabilities mentioned in Point 3 above.
7. The candidate has ensured that the scribe is not a candidate for the same recruitment exercise.
8. The scribe has ensured that he/she is not appearing in the same recruitment exercise.
9. During the exam, at any stage, if it is found that scribe is independently answering the questions, the exam session
will be terminated and candidate’s candidature will be cancelled. The candidature of such candidates using the services
of a scribe will also be cancelled if it is reported after the examination by the test administrator personnel that the
scribe independently answered the questions.
10. All the above statements made by us are true and correct to the best of our knowledge and belief. We also
understand that in case it is detected at any stage of recruitment that we do not fulfill the eligibility norms and/or that
the information furnished by us is incorrect/false or that we have suppressed any material fact(s), the candidature of
the applicant (both the candidate as well as scribe in case he/she has appeared in the same examination) will stand
cancelled, irrespective of the result of the examination. If any of these shortcoming(s) is/are detected even after the
candidate's appointment, his/her services are liable to be terminated. In such circumstances, both signatories will be
liable to criminal prosecution.

I, ____________________________________ (Name of Scribe) certify that I am not a candidate for this recruitment.
I, ____________________________________ (Name of candidate) the candidate for this recruitment certify that I
have ensured that the above scribe is not appearing for this recruitment.

Given under are our signature and contact details: -

SCRIBE CANDIDATE
Signature: Signature:
Name: Name:
Address:
Photo of the Scribe Contact No.: Contact No.:

Signature of Invigilator

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