Page 35 - kcet e_brochure

SPECIMEN OF PRESCRIBED (DIFFERENT TYPES) FORMATS

PROFORMA FOR CAPF / CRPF / CISF / BSF / ITBP UNDER CLAUSE 6(o) OF ITEM 6 OF CHAPTER –1 OF e-BROCHURE
This is to certify that Sri / Kum ………………………………………. DOB……………. Class ………… Name and Place of the Scholl
…………………………is the Son / Daughter of service No. …………….. Rank …………….. Name …………………………… Trade
………………………. Who is / was a combatant member of the ………………………………… wef …………………… and presently
serving at ………………….. (unit) …………………… (place) wef….Service No. ………………. Rank …………….. Name ………………
Trade …………………. Unit …………………. Is / was a CAPF / CRPF / CISF / BSF / ITBP member according to definition as laid down
by Government of Karnataka. His permanent residential address at the time of joining service as per his service documents
is……………………………..………………………………..………………………………………………………………………………….

Date: (Signature of parent)
COUNTERSIGNED BY
Unit Seal
Date: Stamp and signature of the
Commanding Officer
VERIFIED BY
Unit Seal
Date: Stamp and signature of
Director at Integrated HQ of MoD / Chief Records Officer

PROFORMA FOR INCOME CERTIFICATE
TO BE PRODUCED BY GENERAL MERIT CANDIDATES TO CLAIM SUPER NUMERARY QUOTA SEATS
ªÀgÀªÀiÁ£À zÀÈrüÃPÀgÀt ¥ÀæªÀiÁt ¥ÀvÀæ
………..………. f¯ÉèAiÀÄ ……………...………. vÁ®ÆèQ£À …………………. UÁæªÀÄ / ¥ÀlÖtzÀ°è ªÁ¸ÀªÁVgÀĪÀ ²æà / ²æêÀÄw ……………………………… (C¨sÀåyðAiÀÄ vÀAzÉ CxÀªÁ vÁ¬Ä)
gÀªÀgÀÄ ……………………….…. ªÀÈwÛAiÀÄ°è vÉÆqÀVzÀÄÝ, J®è ªÀÄÆ®UÀ½AzÀ CªÀgÀ ªÁ¶ðPÀ ªÀgÀªÀiÁ£À gÀÆ¥Á¬Ä ………………………. EgÀÄvÀÛzÉ. CªÀgÀ ªÀÄUÀ / ªÀÄUÀ¼ÁzÀ
PÀĪÀiÁgÀ / PÀĪÀiÁj ………………………….…. (C¨sÀåyð) EªÀgÀÄ 2019gÀ ¸ÁªÀiÁ£Àå ¥ÀæªÉñÀ ¥ÀjÃPÉëAiÀÄ£ÀÄß vÉUÉzÀÄPÉÆArzÀÄÝ, CzÀPÉÌ ¸ÀA§A¢ü¹zÀAvÉ F
ªÉÄð£À ªÀgÀªÀiÁ£À ¥ÀæªÀiÁt ¥ÀvÀæªÀ£ÀÄß ¥Àj²Ã®£ÉAiÀÄ £ÀAvÀgÀ ¤ÃqÀ¯ÁVzÉ.
¸ÀÞ¼À :
¢£ÁAPÀ :
vÀºÀ¹Ã¯ÁÝgÀªÀgÀ ¸À»
PÀbÉÃjAiÀÄ «¼Á¸À, ªÉƺÀgÀÄ ªÀÄvÀÄÛ zÀÆgÀªÁt ¸ÀASÉå

ANNEXURE – A
ELIGIBILITY CERTIFICATE
[Under Article 371 (J)] (see rule 3(3))
[The Karnataka Public employment (Reservation in Appointment
for Hyderabad-Karnataka Region) Rules for Issual of Certificates, 2013.]
Sri / Smt ………………………………………..……… S/o / W/o …………………….…………………. is a Local Person of the Village / Town
………………………………………….………………. Of Taluka ………………………………………………. Of District of Karnataka State.

Place: ……………………………. Name: ……………………………………………

Date: ……………………………..
Assistant Commissioner
……………………………….. Sub Division
……………………………….. District

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