Instructions

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la ?k yksd ls ok vk;ks x
lfEefyr fpfdRlk ls ok ijh{kk] 2014
mEehnokjks a dks vkos nu&izi =k Hkjus ds ckjs es a funsZ'k
1- mEehnokjksa dks pkfg, fd os vkosnu izi=k Hkjus ls igys bu vkns'kksa dks ?;ku ls i<+ ysaA
2- Hkjk gqvk vkosnu izi=k dh eqfnzr dkWih voj lfpo (lh-,e-,l-)] la?k yksd lsok vk;ksx] /kSyiqj
gkml] 'kkgtgka jksM] ubZ fnYyh&110069 dks fofufnZ"V rkjh[k rd ;k mlls igys vo'; igqap tkuk pkfg,A
3- vkosnu&izi=k ds fyiQkiQs ij ^^lfEefyr fpfdRlk lsok ijh{kk] 2014 ds fy, vkosnu izi=k** fy[kk
gksA vkosnu izi=k la?k yksd lsok vk;ksx ds dkm.Vj ij Lo;a ;k fdlh ds gkFk Hkst dj Hkh tek djk;s tk ldrs
gSaA vk;ksx ds fdlh vU; deZpkjh dks fn, x, vkosnu izi=k ds fy, vk;ksx ftEesnkj ugha gksxkA
4- mEehnokj dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 22 ekpZ] 2014 esa izdkf'kr
mDr ijh{kk dh fu;ekoyh dks lko/kuh ds lkFk i<+ ysa] bl uksfVl esa ik=krk dh 'krksZa vkfn dk mYys[k gSA mUgsa
?;ku j[kuk pkfg, fd vk;ksx mEehnokj }kjk vkosnu&izi=k esa dh xbZ izfof"V;ksa esa ifjorZu ds laca/ esa dksbZ Hkh
i=k&O;ogkj ugha djsxkA vr% ;s vkosnu&izi=k dks Hkjrs le; fo'ks"k lko/kuh cjrsaA
;fn izfof"V;ka viw.kZ gSa ;k Hkzked gSa rks muls gksus okys ifj.kkeksa ds fy, mEehnokj gh ftEesnkj gksxa As
la'kks/ku] ;fn dksbZ gks] Li"V gksus pkfg, rFkk mEehnokj }kjk vuqizekf.kr gksus pkfg,A
5- mEehnokjksa ls vuqjks/ gS fd os vkosnu&izi=k ds lacaf/r dkye esa mu lsokvksa@inksa dks Li"V :i ls
fy[k nsa ftuds fy, os ojh;rkØze esa fopkj.k pkgrs gSaA mUgsa lykg nh tkrh gS fd os ftruh pkgsa mruh
ojh;rkvksa dk mYys[k dj nsa rkfd ;ksX;rkØze esa muds jSad dks è;ku esa j[krs gq, fu;qfDr djrs le; mudh
ojh;rkvksa ij Hkyh&Hkkafr fopkj fd;k tk ldsA
fVIi.kh 1%

jsyos esa lgk;d izHkkxh; fpfdRlk vf/dkjh ds in ds mEenhokjksa dks vkosnu&izi=k esa viuk
fodYi Hkh nsuk gksxk fdUrq mUgsa ;g ojh;rkØe ikap ls vf/d tksuy jsyos dk ugha nsuk pkfg;sA
fofHkUu tksuy jsyos esa mudk vkoaVu djrs le; bu ojh;rkvksa ij Hkh è;ku fn;k tk;sxk ysfdu
bldk vFkZ ;g ugha gS fd mEehnokj dk dsoy buesa ls fdlh ,d jsyos esa gh vkoaVu fd;k
tk;sxkA pwafd ;g lsok lkjs ns'k ds fy, gksrh gS blfy, mEehnokj dks Hkkjrh; jsyos ds fdlh Hkh
tksu esa LFkkukUrfjr fd;k tk ldrk gSA
fVIi.kh 2% vk;ksx mEehnokj dks vius vkosnu&izi=k esa igys fufnZ"V ojh;rk esa dqN Hkh tksM+us@ifjorZu djus
dh vuqefr ugha nsxkA
6. mEehnokj }kjk tks lwpuk igys dh ijh{kk ds vkosnu&izi=k esa nh xbZ Fkh] mudh iM+rky bl ijh{kk ds
vkosnu&izi=k esa nh xbZ lwpukvksa ls dh tk,xhA xaHkhj folaxfr;ka ikbZ tkus ij mudh mEehnokjh jí dj nh
tk,xhA
7- ;fn dksbZ mEehnokj fdlh vuqlwfpr tkfr@vuqlwfpr tutkfr ;k vU; fiNM+h Jsf.k;ksa dk gksus dk nkok djs
rks mls vius nkos ds leFkZu esa ml ftys ds f??tlesa mlds ekrk&firk (;k thfor ekrk ;k firk) vkerkSj ls
jgrs gSa ftyk vf/dkjh ;k mie.My vf/dkjh ;k uhps mfYyf[kr fd, x, ,sls vU; vf/dkjh ftls lac¼ jkT;
ljdkj us ;g izek.k&i=k tkjh djus ds fy, in ukfer fd;k gks] uhps fn, x, iQkeZ esa izek.k&i=k ysdj mldh
[email protected] izfrfyfi izLrqr djuh pkfg,A ;fn mEehnokj ds ekrk vkSj firk nksuksa dh e`R;q gks xbZ gks rks
;g izek.k&i=k ml ftys ds vf/dkjh ls fy;k tkuk pkfg, tgka mEehnokj viuh f'k{kk ls fHkUu fdlh vU;
iz;kstu ls vkerkSj ij jgrk gSA
(d)

Hkkjr ljdkj ds inksa ij fu;qfDr ds fy, vkosnu djus okys vuql wfpr tkfr vkSj vuqlwfpr
tutkfr ds mEehnokjksa }kjk izLrqr fd, tkus okys izek.k&i=k dk iQkeZA

;g izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh* ------------------------------------------------------------------------------------------------ lqiq=k@lqiq=kh* Jh ------------------------------------------------------------------------------- tks xkao@dLck* ------------------------------

---------------------------------------------------------------------- ftyk@eaMy* -------------------------------------------------------------- jkT;@la?k
jkT; {ks=k* -------------------------- ds@dh* fuoklh gS -------------------------------- ------------------- tkfr@tutkfr* ds@dh* gS
ftls fuEufyf[kr ds v/hu vuqlwfpr tkfr@vuqlwfpr tutkfr ds :i esa ekU;rk nh xbZ gS%&
lafo/ku (vuqlwfpr tkfr;ka) vkns'k] 1950 @
lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] 1950 @
lafo/ku (vuqlwfpr tkfr;ka)(la?k jkT; {ks=k) vkns'k] 1951@
lafo/ku (vuqlwfpr tutkfr;ka)(la?k jkT; {ks=k) vkns'k] 1951@
[vuqlwfpr tkfr;ka vkSj vuqlwfpr tutkfr;ka lwph (la'kks/u) vkns'k] 1956_ cEcbZ iquxZBu vf/fu;e]
1960_ iatkc iquxZBu vf/fu;e] 1966_ fgekpy izns'k jkT; vf/fu;e] 1970 vkSj mRrj iwohZ {ks=k (iquxZBu)
vf/fu;e] 1971 rFkk vuqlwfpr tkfr;ka vkSj vuqlwfpr tutkfr;ka (la'kks/u) vf/fu;e] 1976 }kjk ;Fkk
la'kksf/r] fetksje jkT; vf/fu;e] 1986] v:.kkpy izn's k jkT; vf/fu;e] 1986 rFkk xksok] neu vkSj nho
(iquxZBu) vf/fu;e] 1987]
lafo/ku (tEew vkSj dk'ehj) vuqlwfpr tkfr;ka vkns'k] 1956@
lafo/ku (v.Meku vkSj fudksckj }hi lewg) vuqlwfpr tutkfr;ka vkns'k] 1959 vuqlwfpr tkfr rFkk
vuqlwfpr tutkfr;ka (la'kks/u) vf/fu;e] 1976 }kjk ;Fkk la'kksf/r@
lafo/ku (nknjk vkSj ukxj gosyh) vuqlwfpr tkfr;ka vkns'k] 1962@
lafo/ku (nknjk vkSj ukxj gosyh) vuqlwfpr tutkfr;ka vkns'k] 1962@
lafo/ku (ikafMpsjh) vuqlwfpr tkfr;ka vkns'k] 1964@
lafo/ku (mRrj izns'k) (vuqlwfpr tu tkfr;ka) vkns'k] 1967@
lafo/ku (xksok neu vkSj nho) vuqlwfpr tkfr;ka vkns'k] 1968@
lafo/ku (xksok neu vkSj nho) vuqlwfpr tutkfr;ka vkns'k] 1968@A
lafo/ku (ukxkyS.M) vuqlwfpr tutkfr;ka vkns'k] 1970@
lafo/ku (flfDde) vuqlwfpr tkfr;ka vkns'k] 1978@
lafo/ku (flfDde) vuqlwfpr tutkfr;ka vkns'k] 1978@
lafo/ku (tEew vkSj dk'ehj) vuqlwfpr tutkfr;ka vkns'k] 1989@A
lafo/ku (vuqlwfpr tkfr;ka) vkns'k] (la'kks/u) vf/fu;e] 1990@A
lafo/ku (vuqlwfpr tutkfr;ka)vkns'k (la'kks/u) vf/fu;e] 1991@A
lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] (nwljk la'kks/u) vf/fu;e] 1991@A
vuqlwfpr tkfr;ka rFkk vuqlwfpr tutkfr;ka vkns'k (la'kks/u) vf/fu;e] 2002@A
lafo/ku (vuqlwfpr tkfr;ka) vkns'k] (la'kks/u) vf/fu;e] 2002@A
lafo/ku (vuqlwfpr tkfr;ka) vkns'k] (f}rh; la'kks/u) vf/fu;e] 2002@A
lafo/ku (vuqlwfpr tkfr;ka rFkk vuqlwfpr tutkfr;ka) vkns'k (la'kks/u) vf/fu;e] 2002@A
% 2- vuqlwfpr tkfr;ksa@vuqlwfpr tutkfr;ksa ds ,sls O;fDr;ksa ds ekeys esa ykxw tks ,d jkT;@la?k jkT; {ks=k
iz'kklu ls fdlh nwljs jkT;@la?k jkT; {ks=k@iz'kklu esa izoztu dj pqds gSaA
;g izek.k i=k Jh@Jherh@dqekjh* ---------------------------------------------------------------------------- xzke@dLck* -------------------------------------------- ftyk@eaMy* ---------------------------------------------------------------- jkT;@la?k jkT; {ks=k* -------------------------------------------------------------------------------------- tks --------------------------------------------------- tkfr@tutkfr* ls lEc¼ gS ftls
------------------------------------ jkT;@la?k jkT; {ks=k* esa vuqlwfpr tkfr@vuqlwfpr tutkfr* ds :i esa ekU;rk izkIr gSa ds
firk@ekrk* Jh@Jherh* ------------------------------------------------------------------- dh fnukad -----------------ds }kjk dks tkjh izek.k&i=k ds vk/kj ij tkjh fd;k tkrk gSA
% 3- Jh@Jherh@dqekjh* ---------------------------------------------------- vkSj@;k mudk ifjokj vkerkSj ij xkao@dLck*
------------------------------ ftyk@eaMy* ---------------------------------------------------------------- jkT;@la?k jkT; {ks=k* ---------------------------------------------------------- esa jgrs@jgrh gSaA

gLrk{kj
**inuke
(dk;kZy; dh eksgj lfgr)
LFkku --------------------------------------------------rkjh[k ------------------------------------------------jkT;@la?k jkT; {ks=k* ----------------------------*tks 'kCn ykxw u gksa mUgsa dkV nsaWA
@d`i;k jk"V~+ifr dk fof'k"V vkns'k fufnZ"V djsaA
% tks iSjk ykxw u gks mls dkV nsaA
fVIi.kh&
;gka ^^vkerkSj ls jgrs@jgrh gSa** dk vFkZ ogh gksxk tks fjizstsUVs'ku vkiQ fn ihiy ,DV] 1950 dh
/kjk 20 esa gSA
**vuqlwfpr tkfr@vuqlwfpr tutkfr@vU; fiNM+h Jsf.k;ksa dk izek.k&i=k tkjh djus ds fy, l{ke
izkf/dkfj;ksa dh lwphA
(1) ftyk eftLV~s+V@vfrfjDr ftyk eftLVs~+V@dysDVj@fMIVh dfe'uj@,Mh'kuy fMIVh dfe'uj@fMIVh
dysDVj@izFke Js.kh dk LVkbisUMjh eftLV~+sV@†lc&fMfotuy eftLV~s+V@rkyqdk eftLV~+sV@,DthD;wfVo
eftLV+~sV@,DLV~+k vflLVsUV dfe'ujA †(izFke Js.kh ds LVkbisUMjh eftLV~s+V ls de jSad dk u gks)
(2) phiQ izslhMsUlh eftLV~s+V@,Mh'kuy phiQ izslhMsUlh eftLVs~+V@izslhMsUlh eftLV~s+VA
(3) jsosU;w viQlj ftldk vksgnk rglhynkj ls de u gksA
(4) ml bykds dk lc fMfotuy vkfiQlj tgka mEehnokj vkSj@;k mldk ifjokj vkerkSj ls jgrk gksA
([k)

Hkkjr ljdkj ds inksa ij fu;q
fu;qfDr ds fy, vkosnu djus okys vU; fiNMs+ oxksZ ds mEehnokjksa
}kjk izLrqr fd, tkus okys izek.k&i=k dk iQkeZA

izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh* ------------------------------------------------------------ lqiq=k@lqiq=kh* Jh --------------------------------------------------- tks ftyk@eaMy* -------------------------------------------------------------------------- ds xkao@dLck*
-------------------------------------------------------------------- jkT;@la?k jkT; {ks=k* -------------------------------------------------------- ds@dh*
fuoklh gSa ------------------------------- ds leqnk; ds gSa ftls fuEufyf[kr ds v/hu vU; fiNMs+ oxZ ds :i esa ekU;rk
izkIr gS%&
@Hkkjr ds vlk/kj.k jkti=k] Hkkx I] [k.M 1] la[;k 186 esa fnukad 13 flrEcj] 1993 dks izdkf'kr
Hkkjr ljdkj] dY;k.k ea=kky; ds fnukad 10 flrEcj] 1993 ds ladYi la012011@68@93&ch0 lh0lh0(lh0)A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 163 esa fnukad 20 vDrwcj] 1994 dks
izdkf'kr Hkkjr ljdkj] dY;k.k ea=kky; ds fnukad 19 vDrwcj] 1994 dk ladYi la-12011@9@94&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 88 esa fnukad 25 ebZ] 1995 dks izdkf'kr
Hkkjr ljdkj] dY;k.k ea=kky; ds fnukad 24 ebZ] 1995 ds ladYi la-12011@7@95&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 60 esa fnukad 11 ekpZ] 1996 dks izdkf'kr
Hkkjr ljdkj] dY;k.k ea=kky; ds fnukad 9 ekpZ] 1996 dk ladYi la-12011@96@94&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 210 esa fnukad 11 fnlEcj] 1996 dks
izdkf'kr Hkkjr ljdkj] dY;k.k ea=kky; dk fnukad 6 fnlEcj] 1996 dk ladYi la- 12011@44@96&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 236 esa fnukad 12 fnlEcj] 1997 dks
izdkf'kr Hkkjr ljdkj] dY;k.k ea=kky; ds fnukad 11 fnlEcj] 1997 dk ladYi la- 12011@99@94&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 239 esa fnukad 17 fnlEcj] 1997 dks
izdkf'kr Hkkjr ljdkj] dY;k.k ea=kky; dk fnukad 3 fnlEcj] 1997 dk ladYi la- 12011@13@97&ch-lh-lh-A

@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 241 esa fnukad 27 vDrwcj] 1999 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; ,oa vf/dkfjrk ea=kky; ds fnukad 27 vDrwcj] 1999 dk ladYi la12011@68@98&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 270 esa fnukad 6 fnlEcj] 1999 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; ,oa vf/dkfjrk ea=kky; ds fnukad 6 fnlEcj] 1999 ds ladYi la12011@88@98&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 71 esa fnukad 4 vizSy] 2000 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; dk fnukad 4 vizy
S ] 2000 dk ladYi la12011@36@99&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 210 esa fnukad 21 flrEcj] 2000 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 21 flrEcj] 2000 dk ladYi la12011@44@99&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 246 esa fnukad 6 flrEcj] 2001 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; dk fnukad 6 flrEcj] 2001 dk ladYi la12015@9@2000&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 151 esa fnukad 20 twu] 2003 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; dks fnukad 19 twu] 2003 ds ladYi la12011@1@2001&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 9 esa fnukad 13 tuojh] 2004 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 13 tuojh] 2004 dk ladYi la12011@4@2002&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 10 esa fnukad 16 tuojh] 2006 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 16 tuojh] 2006 dk ladYi la12011@9@2004&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k] Hkkx I] [k.M 1] la[;k 67 esa fnukad 12 ekpZ] 2007 dks izdkf'kr Hkkjr
ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; dk fnukad 12 ekpZ] 2007 dk ladYi la0
12011@14@2004&ch0 lh0 lh0A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 232 esa fnukad 18 vxLr] 2010 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; dks fnukad 18 vxLr] 2010 dk ladYi la12015@2@2007&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 274 esa fnukad 12 vDrwcj] 2010 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 11 vDrwcj] 2010 dk ladYi la12015@2@2007&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 123 esa fnukad 16 twu] 2011 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 16 twu] 2011 dk ladYi la12015@15@2008&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 257 esa fnukad 8 fnlEcj] 2011 dks
izdkf'kr Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 8 fnlEcj] 2011 dk ladYi la12015@13@2010&ch-lh--II A

@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 41 esa fnukad 17 iQjojh 2014 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 17 iQjojh] 2014 dk ladYi la12015@05@2014&ch-lh--II A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 63 esa fnukad 4 ekpZ 2014 dks izdkf'kr
Hkkjr ljdkj] lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 4 ekpZ 2014 dk ladYi la20012/129/2009&ch-lh--II A
Jh@Jherh@dqekjh* --------------------------------------------- vkSj@;k* mudk ifjokj lkekU;r;k ftyk@eaMy* ----------------------------- ds xkao@dLck* ---------------------- jkT;@la?k jkT; {ks=k* esa jgrs@jgrh gSaA ;g Hkh izekf.kr fd;k tkrk gS
fd og* dkfeZd rFkk izf'k{k.k foHkkx] Hkkjr ljdkj ds fnukad 8-9-1993 ds dk- Kk- la- 36012@22@93&LFkk(,l-lh-Vh-) vkSj fnukad 9-3-2004 ds dk- Kk- la-36033@3@2004&LFkk-(vkj{k.k) vkSj fnukad 14 vDrqcj] 2008
ds dk- Kk- la-36033@3@2004&LFkk-(vkj{k.k) vkSj fnukad 27-5-2013 ds dk- Kk- la-36033@1@2013&LFkk(vkj{k.k) dh vuqlwph ds dkye 3 es fn, x, O;fDr;ksa@oxksZ* (lEiUu oxZ vFkkZr~ Øhehys;j) ls lEcfU/r ugha
gSA
gLrk{kj --------------------------**inuke -----------------------(dk;kZy; dh eksgj)
jkT;@la?k jkT; {ks=k*
LFkku % --------------------------------fnukad % -------------------------------([k&A) Hkkjr ljdkj ds v/hu inksa ij fu;qfDr ds fy, vkosnu djus okys vU; fiNM+s oxksZa ds
mEehnokjksa }kjk foLr`r vkosnu izi =k ds lkFk esa fn, x, opu dk izk :iA
opu
eSa
---------------------------------------------------------------------iq=k@iq=kh
Jh
-----------------------------------------------------xkao@dLck@'kgj ---------------------------------------------- ftyk --------------------------- jkT; ----------------------- dk fuoklh gwWwAa eSa
,rn}kjk ?kks"k.kk djrk gwWa fd esSa ----------------------- leqnk; dk gwWa ftls dkfeZd ,oa izf'k{k.k foHkkx ds fnukad
8&9&1993 ds dk- Kk- la- 36012@22@93 LFkk- (,l-lh-Vh-)] esa fufgr vkns'kksa ds vuqlkj ukSdfj;ksa esa vkj{k.k ds
fy, Hkkjr ljdkj }kjk fiNMh tkfr ds :i esa ekU;rk nh x;h gSA eSa ;g Hkh ?kks"k.kk djrk gwWa fd eSa fnukad 8-91993 (le;&le; ij la'kksf/r) fnukad 9-3-2004 ds dk- Kk- la- 36033@3@2004&LFkk- (vkj{k.k) vkSj fnukad
14 vDrqcj] 2008 ds dk- Kk- la-36033@3@2004&LFkk- (vkj{k.k) vkSj fnukad 27-5-2013 dS dk- Kk- la- LFkk(vkj{k.k) ds mi;qZDr dk;kZy; Kkiu dh vuqlwph ds dkye 3 esa mfYyf[kr O;fDr;ksa@oxksZ (Øhehys;j) ls lac/
a
ugha gwWaA
gLrk{kj --------------------------mEehnokj dk uke -----------------------vuqdzekad ------------------------fVIi.kh%& ;gka ^^vkerkSj ls jgrs@jgrh gSa** dk vFkZ ogh gksxk tks fjizstsUVs'ku vkiQ fn ihiy ,DV] 1950 dh
/kjk 20 esa gSA
<

*tks 'kCn ykxw u gksa mUgsa dkV nsaWA
**vU; fiNM+s oxZ (vks-ch-lh-) dk izek.k&i=k tkjh djus ds fy, l{ke izkf/dkjh ogh jgsaxs tks v-tk-@v-t-tkds izek.k&i=k tkjh djus ds fy, l{ke gSaA
@tks ykxw u gks mls dkV nsaA
fVIi.kh 1% vU; fiNM+h Jsf.k;ksa dk gksus dk nkok djus okys mEehnokj ;g uksV dj ysa fd muds izek.k&i=k esa
mfYyf[kr mudh tkfr dk uke (mldh orZuh lfgr) dsUnz ljdkj }kjk le;&le; ij vf/lwfpr

lwfp;ksa esa izdkf'kr uke ds vuq:i gksA tkfr ds uke esa fHkUurk ik;a tkus okys izek.k i=k dks
Lohdkj ugha fd;k tk,xkA
fVIi.kh 2% mEehnokj dk vU; fiNM+h Js.kh dk gksus ds nkos dk fu/kZj.k ftl jkT; (;k jkT; ds fgLls) es
mlds firk ewy :i ls laca/ j[krs gSa] dks ?;ku esa j[krs gq, fd;k tk;sxk vr% ftl mEehnokj us
,d jkT; (;k jkT; ds fgLls) ls nwljs jkT; jkT; esa izoztu fd;k gks] mls vU; fiNM+s Js.kh dk
izek.k&i=k izLrqr djuk pkfg, tks mls] mlds firk ds ewy :i ls lacaf/r jkT; }kjk tkjh fd, x,
izek.k&i=k ds vk/kj ij iznku fd;k x;k gkssA
fVIi.kh 3% vk;ksx lkekU;r% mEehnokj }kjk igys bl ijh{kk ds vius ljyhd`r vkosnu i=k esa n'kkZ;h tkrh;
fLFkfr esa fdlh Hkh ifjoZru dh vuqefr ugha nsxkA
8mEehnokjksa dks ,d ,sls izek.k&i=k dh [email protected] izfrfyfi vo'; Hkstuh pkfg,A ftlls bl
ckr dk izek.k fey lds fd ^^jkstxkj lekpkj** fnukad 22 ekpZ] 2014 esa izdkf'kr mDr ijh{kk ds uksfVl ds iSjk 3 (iii)
esa vkSj Hkkjr ds jkti=k] fnukad 22 ekpZ] 2014 esa izdkf'kr mDr ijh{kk dh fu;ekoyh ds fu;e 6 esa izdkf'kr fu/kZfjr
'kSf{kd ;ksX;rk mlds ikl gSA Hkstk x;k izek.k&i=k ml izkf/dkjh (vFkkZr~ fo'ofo|ky; ;k vU; fdlh ijh{kk fudk;) dk
gksuk pkfg, ftlus mls ;ksX;rk fo'ks"k iznku dh gSA
9- mEehnokj dks vk;q ds izek.k&i=k dh ftlesa tUe dh rkjh[k crkbZ xbZ gS] [email protected] izfr vius
vkosnu ds lkFk Hkstuh pkfg,A vk;ksx tUe dh og rkjh[k Lohdkj djrk gS tks eSfV~+dqys'ku ;k ekè;fed fo|ky; NksM+us
ds izek.k&i=k ;k fdlh Hkkjrh; fo'ofo|ky; }kjk eSfV~+dqys'ku ds led{k ekus x, izek.k&i=k ;k fdlh fo'ofo|ky; }kjk
vuqjf{kr eSfV~+dqys'ku ds jftLVj esa nTkZ dh xbZ gks vkSj m¼j.k fo'ofo|ky; ds leqfpr izkf/dkjh }kjk vuqizekf.kr gksA tks
mEehnokj mPprj ekè;fed ijh{kk ;k mldh led{k ijh{kk mRrh.kZ dj pqdk gS og mPprj ekè;fed ijh{kk ;k led{k
ijh{kk ds izek.k&i=k dh [email protected] izfrfyfi izLrqr dj ldrk gSA
vk;q ds lEcU/ esa dksbZ vU; nLrkost tSls tUe dq.Myh] 'kiFk&i=k] uxj fuxe ls rFkk lsok vfHkys[k ls tUe
lEcU/h m¼j.k rFkk ,sls gh vU; izek.k&i=k Lohdkj ugha fd, tk,axsA
vuqns'kksa ds bl Hkkx esa vk, ^^eSfV~+dqys'ku@mPprj ekè;fed ijh{kk izek.k&i=k** okD;ka'k ds vUrxZr mi;qZDr
oSdfYid izek.k&i=k Hkh lfEefyr gSA
dHkh&dHkh eSfV~+dqys'ku@mPprj ekè;fed ijh{kk izek.k&i=k esa tUe dh rkjh[k ugha gksrh gS ;k vk;q ds dsoy iwjs
o"kZ ;k@vkSj eghus gh fn, tkrs gSaA ,sls ekeyksa esa mEehnokj dks eSfV~+dqys'ku@mPprj ekè;fed ijh{kk izek.k&i=k ds vfrfjDr
ml LkaLFkk ds gSMekLVj@fizafliy ls fy, x, izek.k&i=k dh [email protected] izfrfyfi Hkstuh pkfg, tgka ls mlus
eSfV~+dqys'ku@mPprj ekè;fed ijh{kk mRrh.kZ dh gksA bl izek.k i=k esa mls laLFkk ds nkf[kyk jftLVj esa ntZ dh xbZ mldh
tUe dh rkjh[k ;k okLrfod vk;q fy[kh gksuh pkfg,A
mEehnokjksa dks psrkouh nh tkrh gS fd ;fn vkosnu i=k ds lkFk bl vuqns'kksa esa ;Fkk fu/kZfjr vk;q dk iwjk izek.k
ugha Hkstk x;k rks mEehnokj dh mEehnokjh jí dj nh tk,xhA

fVIi.kh 1%&
ftl
l mEehnokj ds ikl i<+k bZ iwjh djus ds ckn izk Ir ekè;fed fo|ky; izek.k&i=k gks mls
1 ft
dso y vk;q ls lEc¼ izfof"V okys i`"B dh [email protected] izfrfyfi Hkstuh pkfg,A
fVIi.kh 2%&
2 mEehnokj ;g è;ku esa j[ks fd vk;ksx mEehnokj dh TkUe dh mlh rkjh[k dks Lohdkj djs
djsx k
tks vkosn u&i=k izLrqr djus dh rkjh[k dks eSfV~+dqy s' ku@ mPprj ekè;fed ijh{kk izek.k&i=k
;k led{k ijh{kk ds izek.k&i=k esa ntZ gS vkSj blds ckn mlesa ifjorZu ds fdlh vuqj ks/
ij u rks fopkj fd;k tk,xk vkSj u gh mls Lohdkj fd;k tk,xkA
fVIi.kh 3%&
mEehnokjj ;g Hkh uksV dj ysa fd muds }kjk fdlh ijh{kk esa izo s'k ds fy, tUe dh rkjh[k
3 mEehnok
,d ckj ?kksf"kr dj nsu s vkSj vk;ksx }kjk mls vius vfHkys[k esa ntZ dj ysu s ds ckn fdlh
Hkh vk/kj ij mlesa ckn esa ;k fdlh ckn dh ijh{kk esa ifjorZu djus dh vuqefr ugh nh
tk,xhA

10- (1) tEew ,oa d'ehj jkT; ds vf/oklh ds :i esa vk;q esa NwV ds ykHk dk nkok djus okys mEehnokj dkss
ml ftyk eftLV~s+V ls] ftlds {ks=kkf/dkj esa og lkekU;r% jgk gS ;k tEew ,oa d'ehj ljdkj }kjk mlds LFkku ij ukfer
fdlh vU; izkf/dkjh ls bl vk'k; ds izek.k&i=k dh vuqizekf.kr@lR;kfir izfr izLrqr djuh gksxh fd igyh tuojh] 1980
ls 31 fnlEcj] 1989 rd dh vof/ ds nkSjku og lkekU;r% tEew ,oa d'ehj jkT; esa gh jgk gSA
(2) vk;q esa NwV pkgus okys ,sls mEehnokj dks tks j{kk lsok esa dk;Z djrs gq, fodykax gqvk gS] egkfuns'kd
iqu% LFkkiuk] j{kk ea=kky; ls fuEufyf[kr fu/kZfjr iQkeZ ij bl vk'k; dk ,d izek.k&i=k ysdj bldh ,d
[email protected] izfrfyfi izLrqr djuh pkfg, fd og j{kk lsok esa dk;Z djrs gq,] fons'kh 'k=kq ns'k ds lkFk la?k"kZ esa
vFkok v'kkafrxzLr {ks=k esa iQkSth dkjZokbZ ds nkSjku fodykax gqvk vkSj ifj.kke&Lo:i fueqZDr gqvkA
mEehnokj }kjk izLrqr fd, tkus okys izek.k&i=k dk iQkeZ fuEu gS%&
izekf.kr fd;k tkrk gS fd ;wfuV ---------------------------------------- ds jSad l- --------------------------------------------------------------------------------- Jh ---------------------------------------------------------------------------------------------- j{kk lsokvksa esa dk;Z djrs gq, fons'kh 'k=kq
ns'k ds lkFk la?k"kZ esa@ v'kkafrxzLr {ks=k esa iQkSth dkjZokbZ· ds nkSjku fodykax gq, vkSj ml fodykaxrk ds ifj.kkeLo:i
fueqZDr gq,A
gLrk{kj -------------------------inuke ---------------------------fnukad ---------------------------*tks 'kCn ykxw u gksa mls d`i;k dkV nsaA
(3) vk;q esa NwV dk nkok djus okys bZ- lh- vks-@,l- ,l- lh- vks- lfgr HkwriwoZ lSfud rFkk deh'kaM vf/dkjh tSlk
muds vius ekeys esa visf{kr gS] izek.k&i=k dh [email protected] izfrfyfi lEc¼ izkf/dkfj;ksa ls ysdj uhps fu/kZfjr
izi=k esa izLrqr djsA
(d) fueqZ Dr@lso k fuo`r dkfeZ d ksksa ds fy, ykxw iz ek.k&i=k dk iz k :iA
izekf.kr fd;k tkrk gS fd la- ---------------------- jSad -------------uke ------------------------------------------------------------------- ftudh
tUe frfFk -------------------------- ls ---------------- rd Fky lsuk@ukS lsuk@ok;q lsuk esa lsok dh gS vkSj og fuEufyf[kr esa ls ,d
'krZ iwjh djrs gSa%&

(d) mUgksaus ikap ;k mlls vf/d o"kZ dh lSU; lsok dh gks vkSj lqiqnZ dk;Z dh lekfIr ij fjgk gq, gksa
vU;Fkk dnkpkj ;k dk;Z vdq'kyrk ds dkj.k c[kkZLr gq, gksaA
([k) lSU; lsok esa 'kkjhfjd v{kerk vFkok ----------------------- dh fodykaxrk ds dkj.k fjgk gq, gksaA
LFkku %
rkjh[k %
l{ke izkf/dkjh dk uke vkSj inuke
eksgj
([k) lso kjr dkfeZd ksa ds fy, ykxw izek.k&i=k dk iQkeZ (mu ls o kjr dkfeZd ksa ij ykxw gksx k ftUgsa ,d o"kZ ds
Hkhrj dk;Z eqD r fd;k tkuk gSA)
eSa ,rn~}kjk izekf.kr djrk gwWa fd esjs ikl miyC/ lwpuk ds vuqlkj la- -------------------- jSad ----------------- uke -------------------------------------------------- fnukad ---------------- ls Fky lsuk@ukS lsuk@ok;q lsuk esa lsokjr gSa vkSj os fnukad ---------------------- dks l'kL=k lsukvksa esa
vius fofu;kstu dh fofufnZ"V vof/ iwjh djus okys gSaA
deku vf/dkjh ds gLrk{kj
dk;kZy; dh eksgj
LFkku%
fnukad%
mDr ^^[k** izek.k&i=k nsus okys mEehnokjksa dks fuEufyf[kr opu nsuk gksxk%&

mEehnokjksa }kjk fn;k tkus okyk
o kyk opu
eq>s Kkr gS fd ;fn bl vkosnu izi=k ls lacaf/r HkrhZ@ijh{kk ds vk/kj ij p;u gks tkrk gS rks ;g fu;qfDr esjs }kjk
fu;qDr izkf/dkjh dks bl vk'k; dk larks"ktud fyf[kr izek.k izLrqr djus ds v/hu gksxh fd eSa l'kL=k lsukvksa ls fof/or~

:i ls fueqZDr@lsokfuo`r@dk;ZeqDr gks x;k gw¡wWa vkSj ;g fd le;&le; ij ;Fkk la'kks/u HkwriwoZ lSfud (dsUnzh; flfoy
lsokvksa rFkk inksa esa iqufuZ;kstu) fu;ekoyh 1979 dh 'krksZ ds vuqlkj HkwriwoZ lSfudksa dks xkzá ykHkksa dk gdnkj gw¡A
mEehnokj ds gLrk{kj
LFkku% -----------------------------fnukad% ---------------------------(x) mu bZ- lhlh-vks- @,l@,l - ,l,l - lhlh- vks- dkfeZ d ij ykxw gksu s okyk iz k :i] ftUgksau s igys gh lso k dh izkjfEHkd fu;q fDr
vof/ iwj h dj yh gS vkSj fu;qf Dr dh c<+k bZ xbZ vof/ ij gS a A
;g izekf.kr fd;k tkrk gS fd la- --------------- jSad ------------- uke -------------------------------------------------------------------- ftudh tUe
frfFk --------------------------------- gS ------------------------- ls Fky lsuk@ukS lsuk@ok;q lsuk esa lsok dj jgs gSaA
2mUgksaus igys gh vkjfEHkd dk;Zdky dh ikap o"kZ dh lsok iwjh dj yh gS vkSj vc os ------------------------------------rd c<+k, x, dk;Zdky ij gSaA
3mUgsa flfoy jkstxkj esa vkosnu&i=k nsus ds fy, dksbZ vkifRr ugha gS rFkk mUgsa flfoy jkstxkj feyus ij rhu ekg
ds uksfVl ij dk;ZeqDr fd;k tk,xkA

l{ke izkf/dkjh dk uke vkSj inuke
dk;kZy; dh eksgj
LFkku% ----------------------------fnukad% --------------------------izkf/dkjh tks izek.k&i=k tkjh djus ds fy, l{ke gS fuEu izdkj gS%&
(d) bZ-lh-vks-@,l-,l-lh-vks- lfgr deh'kaM vf/dkfj;ksa ds ekeys esa%&
Fky lsuk&fefyVjh lfpo dh 'kk[kk] Fky lsuk eq[;ky;] ubZ fnYyhA
ukS lsuk&dkfeZd lsok funs'kky;] (vf/dkjh)] ukS lsuk eq[;ky;] ubZ fnYyhA
ok;q lsuk&dkfeZd lsok funs'kky;] ok;q lsuk eq[;ky;] ubZ fnYyhA
([k) ts-lh-vks-@vks-vkj- rFkk ukS lsuk rFkk ok;q lsuk led{k ds ekeys esa%&
Fky lsuk & fofHkUu jsthesUVy vfHkys[k dk;kZy;ksa }kjkA
ukS lsuk & ch-,-ch-,l-] eqEcbZA
ok;q lsuk & ok;q lsuk vfHkys[k ,u-bZ-vkj-MCY;w-] ubZ fnYyhA

(4) og mEehnokj ftlus 'kkjhfjd :i ls v{ke gksus ds dkj.k 'kqYd esa NwV vkSj@;k vk;q&lhek esa NwV dk nkok fd;k gS]
mls uhps fn, x, izk:i esa fpfdRlk cksMZ (dsUnzh; ;k jkT; ljdkj }kjk xfBr) }kjk tkjh fd, x, izek.k&i=k dh
vuqizekf.kr izfr izLrqr djuh pkfg,A

प - ।
अश त यि तय वारा अश तता माण-प ात करने हे तु आवेदन-प
(नयम 3 दे ख!)
1.

नाम .......................... ......................
(उप नाम)

( थम नाम)

.........................

(म
य नाम)

2.

पता का नाम ........................ माता का नाम ................................

3.

जम तथ ___________/______________/______________
(दनांक)

(माह)

(वष)

4.

आवेदन के समय आयु : _________________वष

5.

(लंग :

6.

पता :

पु+ष/महला

(क) -थायी पता:

(ख) वतमान पता (अथात प1-3यवहार के (लए)

........................................

..................................................

..........................................

..................................................
(ग) वतमान पते पर नवास करने क6 अवध
.........................................

7.

8.

शै;<णक यो?यता (कृपया जो लागू हो उसे चिहत करD )
(I)

-नातकोEतर

(II)

-नातक

(III)

FडHलोमा

(IV)

हायर सेकDडरI

(V)

हाई -कूल

(VI)

(मFडल

(VII)

ाइमरI

(VIII)

अ(शL;त

3यवसाय ..................................................................................

9.

पहचान के चह (i) ............................... (ii) ...............................

10.

अशPतता क6 कृत : चलने मD असमथ/Qवण बाधत/ SिTट बाधत/ मान(सक/अय

11.

वह अवध जब से अशPत हV : जम से/...............वष से

12.

(i) Pया आपने कभी पूव मD अशPतता माण प1 जारI करने के (लए आवेदन Xकया है
.................हां/नहI
(ii)

13.

यद हां, तो ववरण दD :
(क)

Xकस ाधकारI और िजले मD आवेदन Xकया है ....................

(ख)

आवेदन का प[रणाम ..........................................

Pया आपको पूव मD कभी अशPतता माण प1 जारI Xकया गया है ? यद हां, तो कृपया सहI
त(लप संल?न करD ।

घोषणा : मV एतद_वारा यह घोषणा करता/करती हूं Xक उपयP
ु त सभी ववरण मेरI जानकारI और
व`वास के अनस
ु ार सEय हV और कोई महEवपूण जानकारI छपाई नहIं गई है अथवा गलत नहIं 3यPत
क6 गई है । मV यह भी घोषणा करता/करती हूं Xक यद मेरे आवेदन प1 मD कोई गलती पाई जाती है तो
मुझे ाHत लाभ, यद कोई हो, जcत Xकया जा सकता है और वध के अनस
ु ार मेरे व+d अय
कायवाहI क6 जा सकती है ।

(अशPत 3यिPत अथवा मान(सक, ऑटfम,
मि-तषक6य प;ाघात और एकाधक
अशPतता वाले 3यिPतयg के मामले मD
उनके नधक संर;क के ह-ता;र अथवा
बाएं हाथ के अंगूठे का नशान)
दनांक :
-थान :
संल?नक :
1.

नवास का माण (कृपया जो लागू हो उसे चिहत करD )
(क)

राशन काड,

(ख)

मतदाता पहचान प1,

(ग)

iाइवंग लाइसDस,

(घ)

बVक पासबुक,

(ड.)

पैन काड,

(च)

पासपोट,

(छ)

टे लIफोन, व_युत, जल और अय उपभोfय kबल िजसमD आवेदक का पता (लखा हो,

(ज)

पंचायत, नगर नगम, कVटोनमD ट बोड, Xकसी राजपk1त अधकारI अथवा संबंधत
पटवारI अथवा Xकसी सरकारI -कूल के है डमा-टर _वारा जारI नवास माण प1,

(झ)

अशPत, नराQत, मान(सक रोग, आद से l-त 3यिPतयg के (लए नवास सं-थान
के मामले मD ऐसे सं-थान के मख
ु से नवास माण प1

2.

दो नवीनतम पासपोट साइज़ फोटोlाफ

----------------------------------------------------------------------------------------(केवल कायालय उपयोग के (लए)

दनांक :

जारI करने वाले ाधकारI के ह-ता;र

-थान :

मोहर

प1 -।।
अशPतता माण प1
(अंगoछे दन या अंगg के पूण +प से -थायी प;ाघात के मामले मD और SिTटहIन 3यिPतयg के मामले मD )
( माण प1 जारI करने वाले चXकEसा ाधकारI का नाम और पता)
अशPत 3यिPत का वतमान
पासपोट आकार का
सEयापत फोटो (केवल चेहरा
दशाया हो)

माण प1 सं.
यह

दनांक :
मा<णत

Xकया जाता

है

Xक मVने

Qी/Qीमती/कुमारI __________________________________________________

__________________ पु1/पEनी/पु1ी Qी __________________________ जम तथ ____
महला ______
सं.

____

____

आय ु _______वष, पु+ष/

( दनांक / माह / वष )

_______________________________

-थायी

नवासी

मकान

नं.

पंजीकरण
_________________

वाड/lाम/-pIट_________________________ डाकघर ________________ िजला ______________ राfय ________________ और
िजनका फोटोlाफ ऊपर लगाया गया है , क6
यानपूवक जांच कर लI है और मV संतुTट हूं Xक :
(क)
वह नrन रोग से l-त हV:


चलने मD असमथ



SिTटहIन
(कृपया जो लागू हो उसे चिहत करD )

(ख)

उनके मामले मD .............................नदान है ।

(ग)

मागनदs शg के अनस
ु ार (वशेष +प से उtलेख) उहD .......................% (अंकg मD ) .................................... तशत (शcदg मD ) उनके
(शरIर के अंग) के संबंध मD -थायी शारI[रक अ;मता/SिTट बाधता हV।

2.

आवेदक ने अपने नवास के माण -व+प नr न(ल<खत द-तावेज -तुत Xकया है :द-तावेज क6 कृत

जारI करने क6 तारIख

माण प1 जारI करने वाले ाधकारI का ववरण

(अधसू चत चXकEसा ाधकारI के ाधकृत ह-ता;रकता के

उस 3यिPत के
ह-ता;र/अंगठ
ू े का नशान
िजसके नाम से अशPतता
माण प1 जारI Xकया
गया है ।

ह-ता;र और मोहर)

प–।।।
अश तता माण प
(एकाधक अशPतता के मामले मD )
( माण प1 जारI करने वाले चXकEसा ाधकारI का नाम एवं पता)
अशPत 3यिPत का
वतमान पासपोट
आकार का सEयापत
फोटो (केवल चेहरा
दशाया हो)

माण प1 सं.

दनांक :

यह

मा<णत

Xकया

जाता

है

Xक

मVने

Qी/Qीमती/कुमारI

_______________________________________________

_____________________ पु1/पEनी/पु1ी Qी ________________________ जम तथ ____ ____ ____
महला ______

आय ु _______वष, पु+ष/

( दनांक/ माह/ वष )

_____________

-थायी

नवासी

मकान

नं.

___________वाड/lाम/-pIट________________

पंजीकरण

डाकघर

सं.

________________

िजला______________ राfय ________________ और िजनका फोटोlाफ ऊपर लगाया गया है , क6
यानपूवक जांच कर लI है और मV संतुTट
हूं Xक :
(क)

वह नrन एका%धक अश तता से l-त हV। मागनदs शg के अनुसार (वशेष +प से उtलेख) उनक6 -थायी शारI[रक

दौबtय/अशPतता क6 सीमा को आक(लत Xकया गया है और नीचे ता(लका मD संगत अशPतता के सामने दशाया गया है :
'म सं.

अश तता

शर+र का भा-वत अंग

नदान

/थायी शार+2रक दौब56य/ मान8सक
अश तता (% म! )

@

1.

चलने मD असमथ

2.

कम SिTट

#

3.

SिTटहIन

दोन आंख से

4.

Qवण बाधत

£

5.

मान(सक मदता

X

6.

मान(सक-3याध

X

(ख)

उपयुPत के मwेनजर, मागनदs शg के अनुसार (वशेष +प से उtलेख) उनका समl -थायी शारI[रक दौबtय नrनानुसार है :(अंकg मD ) ........................... तशत
(शcदg मD ) ............................................................................................... तशत

2.

इस ि-थत के आगे और बढ़ने/न बढ़ने/ि-थत मD सध
ु ार होने/सध
ु ार न होने क6 संभावना है ।

3.

अशPतता का आकलन :
(i) आव`यक नहIं है,
अथवा
(ii) क6 अनुशंसा क6 जाती है/...............वषy ............. माह के उपरांत और इस(लए यह माण प1 ............
के (लए वैध रहे गा।

@

उदाहरण बायां/दायां/दोन हाथ/पैर

#

उदाहरण एक आंख/दोन आंख

£

उदाहरण बायां/दायां/दोन कान

(दनांक)

(माह)

.............. ......... तक
(वष)

4. आवेदक ने अपने नवास के माण -व+प नr न(ल<खत द-तावेज -तुत Xकया है:द-तावेज क6 कृत

जारI करने क6 तारIख

माण प1 जारI करने वाले ाधकारI का ववरण

सद-य का नाम और मोहर


य; का नाम और मोहर

5. चXकEसा ाधकारI के ह-ता;र और मोहर

सद-य का नाम और मोहर

उस 3यिPत के
ह-ता;र/अंगठ
ू े का
नशान िजसके नाम से
अशPतता माण प1
जारI Xकया गया है ।

प – IV
अश तता माण प
(फाम II और III मD उिtल<खत मामलg से अयथा)
( माण प1 जारI करने वाले चXकEसा ाधकारI का नाम और पता)

अशPत 3यिPत का
वतमान पासपोट आकार
का सEयापत फोटो (केवल
चेहरा दशाया हो)

माण प1 सं.

दनांक :

यह मा<णत Xकया जाता है Xक मVने Qी/Qीमती/कुमारI ________________________________________________________
____________

पु1/पEनी/पु1ी

Qी

________________________

जम

महला ______
सं.

तथ

____

____

(दनांक / माह /

_____________

-थायी

नवासी

मकान

नं.

____

आय ु

_______वष,

___________वाड/lाम/-pIट________________

पु+ष/

पंजीकरण

वष )

डाकघर

________________

िजला______________ राfय ________________ और िजनका फोटोlाफ ऊपर लगाया गया है , क6
यानपूवक जांच कर लI है और मV संतुTट
हूं Xक वह .................... अशPतता से l-त हV। मागनदs शg के अनस
ु ार (वशेष +प से उtलेख) उनक6 -थायी शारI[रक दौबtय/अशPतता के
तशत क6 सीमा को आक(लत Xकया गया है और नीचे ता(लका मD संगत अशPतता के सामने दशाया गया है :
'म सं.

अश तता

शर+र का भा-वत अंग

नदान

/थायी शार+2रक दौब56य/मान8सक
अAमता (% म! )

@

1.

चलने मD असमथ

2.

कम SिTट

#

3.

SिTटहIन

दोन आंख से

4.

Qवण बाधत

£

5.

मान(सक मदता

X

6.

मान(सक 3याध

X

(कृपया उस अशPतता को काट दD जो लागू नहIं हV)
2.

इस ि-थत के आगे और बढ़ने/न बढ़ने/ि-थत मD सुधार होने/सुधार न होन क6 संभावना है ।

3.

अशPतता का आकलन :
(i) आव`यक नहIं है,
अथवा
(ii) क6 अनश
ु ंसा क6 जाती है /.......... वषy .......... माह के उपरांत और इस(लए यह माण प1 ................
(लए वैध रहे गा ।

@

उदाहरण बायां/दायां/दोन हाथ/पैर

#

उदाहरण एक आंख/दोन आंख

£
4.

.............. ......... तक के

(दनांक)

(माह)

(वष)

उदाहरण बायां/दायां/दोन कान
आवेदक ने अपने नवास के माण -व+प नr न(ल<खत द-तावेज -तत
ु Xकया है :द-तावेज क6 कृत

जारI करने क6 तारIख

माण प1 जारI करने वाले ाधकारI का ववरण

(अधसू चत चXकEसा ाधकारI के ाधकृत ह-ता;रकता)
(नाम और मोहर)

तह-ता;र

{यद यह माण प1 ऐसे चXकEसा ाधकारI _वारा जारI Xकया गया है जो एक
उस 3यिPत के
ह-ता;र/अंगठ
ू े का
नशान िजसके नाम
से अशPतता माण
प1 जारI Xकया गया
है ।

सरकारI कमचारI नहIं है तो यह म{
ु य चXकEसा अधकारI/चXकEसा अधी;क/
सरकारI अ-पताल के मख
ु _वारा तह-ता;र Xकए जाने पर
हI वैध होगा (मोहर सहत)}

टHपणी : यद यह माण प1 ऐसे चXकEसा ाधकारI _वारा जारI Xकया गया है जो एक सरकारI कमचारI नहIं है तो यह उस िजले के मु{य
चXकEसा अधकारI _वारा तह-ता;र Xकए जाने पर हI वैध होगा।"
टHपणी : मु{य नयम दनांक 31 दसrबर, 1996 क6 अधसूचना सं. एस.ओ. 908 (ई) के तहत भारत के राजप1 मD का(शत Xकए गए थे।

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os ik=krk dh fdUgha 'krksZa dks iwjk ugha djrs
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12- mEehnokjksa dks vius vkosnu izi=kksa ds lkFk fuEufyf[kr izys[k vuqyXu dj vk;ksx dks Hkstus gSa%&
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[email protected] izfrfyfi (tgka dgha ykxw gks)A
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tk,xhA mEehnokj ;fn xk;c vuqyXudksa dks ckn esa Hkstrs gSa rks mUgsa Lohdkj ugha fd;k tk,xkA mEehnokj ;g vo';
lqfuf'pr dj ysa fd vkosnu izi=k Bhd ls Hkstk x;k gS vkSj mlds lkFk lHkh laxr vuqyXud Hksts x, gSaA vkosnu izi=k
dk dksbZ Hkh dkye fjDr u NksM+k tk,A
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vkbZ-Mh- (11 vafd;) vkSj tUe rkjh[k vo'; fy[ksaA

UNION PUBLIC SERVICE COMMISSION
COMBINED MEDICAL SERVICES EXAMINATION, 2014
INSTRUCTIONS TO CANDIDATES FOR FILLING IN THE APPLICATION FORM

1. The candidates should read these instructions carefully before filling in the application form.
2. The prinout of the completed application form must reach the Under Secretary (CMS), Union
Public Service Commission, Dholpur House, Shahjahan Road, New Delhi-110069 on or before the
specified date.
3. The envelope containing the application should be superscribed as ‘Application for Combined
Medical Services’ Examination, 2014. Application can also be delivered at Union Public Service
Commission counter by hand. The Commission will not be responsible for the applications delivered to
any other functionary of the Commission.
4. Candidates are advised to read carefully the Rules of the Examination, which include conditions
of eligibility etc. as published in the Gazette of India dated 22nd March, 2014. They should note that no
correspondence will be entertained by the Commission from candidates to change any of the entries
made in the application form. They should, therefore, take special care to fill up the online application
form correctly.
In case there are any incomplete or misleading entries, the candidates will be responsible for the
consequences thereof.
5. Candidates are requested to specify clearly in the relevant column of the application form the
Services/Posts for which they wish to be considered in order of preference. They are advised to indicate
as many preferences as they wish to so that having regard to the rank in the order of merit, due
consideration can be given to their preferences when making appointment.
Note I :

Candidates for the post of Asstt. Divisional Medical Officer in the Railways are also required
to give their option for not more than five Zonal Railways in order of preference. While
making their allocation to the various Zonal Railways these preferences shall be taken into
consideration but it does not mean that the candidate shall be allocated to one of these
Railways only. As the service is meant to cover the entire country, a candidate is transferable
to any zone of the Indian Railways.

Note II :

No request for addition/alteration in the preferences already indicated by a candidate in
his/her application will be entertained by the Commission.

6. The information earlier given by candidates in the application form for the Examination will be
cross-checked with the information given by them in this application form. If there are any serious
discrepancies, their candidature will be cancelled.
7. A candidate who claims to belong to any of the Scheduled Castes, the Scheduled Tribes or the
Other Backward Classes should submit in support of his/her claim an attested/certified copy of the
certificate in the form given below from the District Officer or the Sub-Divisional Officer or any other
officer as indicated below of the district in which his/her parents (or surviving parents) ordinarily reside.
Such an officer should have been designated by the State Government concerned as competent to issue
such a certificate. If both his/her parents are dead, the officer signing the certificate should be of the
district in which the candidate himself/herself ordinarily resides otherwise than for the purpose of
his/her own education.
A. The form of certificate to be produced by Scheduled Castes and Scheduled Tribes candidates
applying for appointment to posts under the Government of India.
This is to certify that Shri/Shrimati/Kumari*............................................................... son/daughter*
of Shri .............................................. of village/town*......................... in District/Division* .......................
of the State/Union Territory* ....................... belongs to the .......................... caste/tribe* which is
recognised as a Scheduled Caste/Scheduled Tribe* under :—
the Constitution (Scheduled Castes) Order, 1950@.
the Constitution (Scheduled Tribes) Order, 1950@.
the Constitution (Scheduled Castes) (Union Territories) Order, 1951@.
the Constitution (Scheduled Tribes) (Union Territories) Order, 1951@.
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order, 1956; the
Bombay Reorganisation Act, 1960; the Punjab Reorganisation Act, 1966; the State of Himachal Pradesh

Act, 1970; the North Eastern Areas (Reorganisation) Act, 1971 and the Scheduled Castes and Scheduled
Tribes Order (Amendment) Act, 1976. the State of Mizoram Act, 1986, the State of Arunachal Pradesh
Act, 1986 and the Goa, Daman & Diu (Reorganisation) Act, 1987.]
the Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956@.
the Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended by the
Scheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976. @
the Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.@
the Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962.@
the Constitution (Pondicherry) Scheduled Castes Order, 1964.@
the Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967.@
the Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968.@
the Constitution (Goa, Daman and Diu) 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 (Jammu & Kashmir) Scheduled Tribes Order, 1989.@
the Constitution (SC) Order (Amendment) Act, 1990.@
the Constitution (ST) Order (Amendment) Act, 1991.@
the Constitution (ST) Order (Second Amendment) Act, 1991.@
the Constitution (Scheduled Castes) Order (Amendment) Act, 2002@
the Constitution (Scheduled Castes and Scheduled Tribes) Order (Amendment) Act, 2002@
the Constitution (Scheduled Castes) Order (Second Amendment) Act, 2002@
%2. Applicable in the case of Scheduled Caste/Scheduled Tribe persons who have migrated from one
State/Union Territory Administration to another.
This certificate is issued on the basis of the Scheduled Caste/Scheduled Tribe* certificate issued to
Shri/Shrimati* .................................................. Father/Mother of Shri/Shrimati/Kumari* ..........................
............... of village town* ......................... in District Division*.................................... of the State/Union
Territory*......................................... who belongs to the ................................................. caste/tribe*which
is recognised as a Scheduled Caste/Scheduled Tribe* in the State/Union Territory* of
........................................... issued by the ................................................ dated ..................................
% 3. Shri/Shrimati/Kumari* ............................................... and/or* his/her* family ordinarily
reside(s) in village/town* .................................. of ................................. District/Division* of the
State/Union Territory* of ...............................................
Signature .............................................
**Designation .........................................
(With Seal of Office)
Place : .............................
Date : .............................
State/Union Territory*
*Please delete the words which are not applicable.
@Please quote specific Presidential Order.
% Delete the paragraph which is not applicable.
Note : The term “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 Scheduled Caste/Scheduled Tribe/OBC Certificates.
(i) District Magistrate/Additional District Magistrate/ Collector/Deputy Commissioner/Additional
Deputy Commissioner/Deputy Collector/1st Class Stipendiary Magistrate/†Sub-Divisional
Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner.
†(not below the rank of 1st Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.

(iv) Sub Divisional Officer of the area where the candidate and/or his/her family normally resides.
(B) The form of certificate to be produced by Other Backward Classes candidates applying for
appointment to posts under the Government of India.
This is to certify that Shri/Shrimati/Kumari*.................................................. son/daughter*
of ......................................... village/town* ......................... in District/Division*........................ of the
State/Union Territory*....................................... belongs to the ................................ Community which is
recognised as a backward class under :
@Government of India, Ministry of Welfare Resolution No.12011/68/93-BCC(C) dated 10th
September, 1993 published in the Gazette of India, Extraordinary Part-I, Section-1, No.186 dated the
13th September, 1993.
@Government of India, Ministry of Welfare Resolution No.12011/9/94-BCC dated 19-10-94,
published in the Gazette of India Extraordinary Part-I, Section-1, No.163 dated 20-10-1994.
@Government of India, Ministry of Welfare Resolution No.12011/7/95-BCC dated 24-5-95,
published in the Gazette of India Extraordinary Part-I, Section-1, No.88 dated 25-5-1995.
@Government of India, Ministry of Welfare Resolution No.12011/96/94-BCC dated 9th March,
1996 published in the Gazette of India Extraordinary Part-I, Section-1, No.60 dated 11th March, 1996.
@Government of India, Ministry of Welfare Resolution No.12011/44/96-BCC dated 6th
December, 1996 published in the Gazette of India Extraordinary Part-I, Section-1, No.210 dated 11-121996.
@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-1, No.236 dated the 12th
December, 1997.
@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-1, No. 239 dated the
17th December, 1997.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/68/98BCC dated the 27th October, 1999 published in the Gazette of India Extraordinary Part-I, Section-1, No.
241 dated the 27th October, 1999.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/88/98BCC dated the 6th December, 1999 published in the Gazette of India Extraordinary Part-I, Section-1,
No. 270 dated the 6th December, 1999.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/36/99BCC dated 4th April, 2000 published in the Gazette of India Extraordinary Part-I, Section-1, No. 71
dated the 4th April, 2000.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/44/99BCC dated the 21st September, 2000 published in the Gazette of India Extraordinary Part-I, Section-1,
No. 210 dated the 21st September, 2000.
@Government of India, Ministry of Social Justice and Empowerment Resolution
No.12015/9/2000-BCC dated the 6th September, 2001 published in the Gazette of India Extraordinary
Part-I, Section-1, No. 246 dated the 6th September, 2001.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12011/1/2001-BCC dated 19th June, 2003 published in the Gazette of India Extraordinary Part-I,
Section-1, No.151 dated the 20th June, 2003.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12011/4/2002-BCC dated 13th January, 2004 published in the Gazette of India Extraordinary Part-I,
Section-1, No. 9 dated the 13th January, 2004.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12011/9/2004-BCC dated 16th January, 2006 published in the Gazette of India Extraordi-nary Part-I,
Section-1, No. 10 dated the 16th January, 2006.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12011/14/2004-BCC dated 12th March, 2007 published in the Gazette of India Extraordi-nary Part-I,
Section-1, No. 67 dated the 12th March, 2007.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12015/2/2007-BCC dated 18th August, 2010 published in the Gazette of India Extraordinary Part-I,
Section-1, No. 232 dated the 18th August, 2010.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12015/2/2007-BCC dated 11th October, 2010 published in the Gazette of India Extraordinary Part-I,
Section-1, No.274 dated the 12th October, 2010.
@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12015/15/2008-BCC dated 16th June, 2011 published in the Gazette of India Extraordinary Part-I,
Section-1, No.123 dated the 16th June, 2011.

@Government of India, Ministry of Social Justice and Empowerment Resolution No.
12015/13/2010-BC-II dated 8th December, 2011 published in the Gazette of India Extraordinary Part-I,
Section-1, No. 257 dated the 8th December, 2011.
@ Government of India, Ministry of Social Justice and Empowerment Resolution
No.12015/05/2011-BC-II dated the 17th February, 2014 published in the Gazette of India Extraordinary
Part-I, Section-1, No.41 dated the 17th February, 2014.
@ Government of India, Ministry of Social Justice and Empowerment Resolution
No.20012/129/2009-BC-II dated the 4th March, 2014 published in the Gazette of India Extraordinary
Part-I, Section-1, No.63 dated the 4th March, 2014.
Shri/Shrimati/Kumari*........................................................... and/or* his/her* family ordinarily reside(s) in
village/town*..................................... of District/Division* of the ...................................... State/Union Territory* of ......................................
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 & Training O.M. No. 36012/22/93-Estt(SCT) dated 8-9-1993,
O.M. No. 36033/3/2004-Estt.(Res.) dated 9th March, 2004 and O.M. No. 36033/3/2004-Estt.(Res.) dated
14th October, 2008 and O.M.No.36033/1/2013-Estt. (Res.) dated 27th May, 2013.
Signature................................
**Designation............................
(with seal of office) State/U.T.*
Place....................................................
Date.....................................................
(B-1) The format of undertaking to be furnished along with the Detailed Application Form by
Other Backward Class candidates applying for appointment to posts under the Government of
India.
UNDERTAKING
I .......................................................... son/daughter of Shri ...................................................
resident of Village/Town/City .......................... District .................... State/UT .............. hereby declare
that I belong to the .................................. community which is recognized as a backward class by the
Government of India for the purpose of reservation in services as per orders contained in Department of
Personnel & Training Office Memorandum No.36012/22/93-Estt(SCT) dated 08.09.1993. It is also
declared that I do not belong to persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule
to the above referred Office Memorandum dated 08.09.1993 and O.M. No.36033/3/2004-Estt. (Res.)
dated 9.3.2004 and 14.10.2008 and O.M.No.36033/1/2013-Estt. (Res.) dated 27th May, 2013 as amended
from time to time.
Signature .................................
Name of the Candidate .......................... ......
Roll No .................................
Note : The term ‘‘ordinarily reside(s)’’ used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1950.
*Please delete the words which are not applicable.
**Authorities empowered to issue Other Backward Classes certificate will be the same as those
empowered to issue Scheduled Castes/Scheduled Tribes certificates.
@Strike out whichever is not applicable.
Note 1 : Candidates claiming to belong to OBCs should note that the name of their caste (including its
spellings) as indicated in their certificates, should be exactly the same as published in the lists
notified by the Central Government from time to time. A certificate containing any variation in
the caste name will not be accepted.
Note 2 : The OBC claim of a candidate will be determined in relation to the State (or part of the State) to
which his/her father originally belongs. A candidate who has migrated from one State (or part of
the State) to another should, therefore, produce an OBC certificate which should have been
issued to him/her based on his/her father’s OBC certificate from the State to which he (father)
originally belongs.
Note 3 : No change in the community status already indicated by a candidate in his/her simplified
application form for this examination will ordinarily be allowed by the Commission.
8. A candidate must submit alongwith his/her application an attested/certified copy of the
certificate showing his/her educational qualification prescribed in para 3(iii) of the Notice for the
Examination published in the Employment News dated 22nd March, 2014 and in Rule 6 of the rules
for the Examination published in the Gazette of India dated 22nd March, 2014. The certificate submitted
must be one issued by the authority (i.e. University or other examining body) awarding the particular
qualification.

9. A candidate must enclose with his/her printed copy of application an attested/certified copy of
certificate of age (including his/her date of birth). The date of birth accepted by the Commission is that
entered in the Matriculation or Secondary School Leaving Certificate or in a certificate recognised by an
Indian University as equivalent to Matriculation or in an extract from a Register of Matriculates
maintained by a University which must be certified by the proper authority of the University. A
candidate who has passed the Higher Secondary Examination or an equivalent Examination may submit
an attested/certified copy of the Higher Secondary Examination certificate or an equivalent certificate.
No other document relating to age like horoscopes, affidavits, birth extracts from Municipal
Corporation, Service Records and the like, will be accepted.
The expression Matriculation/Higher Secondary Examination certificate in this part of the
instruction includes the alternative certificate mentioned above.
Sometimes the Matriculation/Higher Secondary Examination Certificate does not show the date of
birth or only shows the age by completed years or completed years and months. In such cases, a
candidate must send in addition to the Matriculation/Higher Secondary Examination certificate an
attested/certified copy of the certificate from the Headmaster/Principal of the Institution from where
he/she passed the Matriculation/Higher Secondary Examination, showing date of his/her birth or his/her
exact age as recorded in the Admission Register of the Institution.
Candidates are warned that unless complete proof of age as laid down in these instructions is sent
with the application, the candidature of the candidate will be rejected.
Note 1 : A CANDIDATE WHO HOLDS A COMPLETED SECONDARY SCHOOL CERTIFICATE NEED
SUBMIT AN ATTESTED/CERTIFIED COPY OF THE PAGE CONTAINING ENTRIES RELATING
TO AGE ONLY.
Note 2 : CANDIDATES SHOULD NOTE THAT ONLY THE DATE OF BIRTH AS RECORDED IN THE
MATRICULATION / HIGHER SECONDARY EXAMINATION CERTIFICATE OR AN
EQUIVALENT CERTIFICATE ON THE DATE OF SUBMISSION OF APPLICATION WILL BE
ACCEPTED BY THE COMMISSION AND NO SUBSEQUENT REQUEST FOR ITS CHANGE WILL
BE CONSIDERED OR GRANTED.
Note 3 : CANDIDATES SHOULD ALSO NOTE THAT ONCE DATE OF BIRTH HAS BEEN CLAIMED BY
THEM AND ENTERED IN THE RECORDS OF THE COMMISSION FOR THE PURPOSE OF
ADMISSION TO AN EXAMINATION, NO CHANGE WILL BE ALLOWED SUBSEQUENTLY OR
AT A SUBSEQUENT EXAMINATION ON ANY GROUND WHATSOEVER.

10 (i) A candidate claiming age-relaxation as a domicile of the State of Jammu and Kashmir should
produce an attested/certified copy of a certificate from the District Magistrate within whose jurisdiction
he/she had ordinarily resided or from any other authority designated in that behalf by the Government of
Jammu and Kashmir to the effect that he/she had ordinarily been domiciled in the State of Jammu and
Kashmir during the period from the 1st January, 1980 to the 31st day of December, 1989.
(ii) A candidate disabled while in the Defence Services claiming age concession should produce an
attested/certified copy of the certificate in the form prescribed below from the Director General
Resettlement, Ministry of Defence to show that he was disabled while in the Defence Services in
operations during hostilities with any foreign country or in a disturbed area and released as a
consequence thereof.
The form of certificate to be produced by the candidate is :—
Certified that Rank No. ................................... Shri ................................................................... of
Unit ..................................... was disabled while in the Defence Services in operations during hostilities
with a foreign country/in a disturbed area* and was released as a result of such disability.
Signature.....................................
Designation.................................
Date................................
*Strike out whichever is not applicable.
(iii) Ex-servicemen including the Commissioned Officers and ECOs/SSCOs claiming age
concession should produce an attested/certified copy of the certificate as applicable to them, in the form
prescribed below from the authorities concerned.
(A) Form of certificate applicable for Released/Retired personnel.
It is certified that No............................... Rank ........................ Name ................................................
..................... whose date of birth is .......................... has rendered service from ................... to
................... in Army/Navy/Air Force and he fulfils ONE of the following conditions—
(a) Has rendered five or more years military service and has been released on completion of
assignment otherwise than by way of dismissal or discharge on account of misconduct or
inefficiency.
(b) Has been released on account of physical disability attributable to military service or on
invalidment on .....................................

Station : ...........................
Date : ...............................
Name and Designation of the
Competent Authority
SEAL
(B) Form of certificate applicable for serving personnel (Applicable for serving personnel
who are due to be released within one year).
I hereby certify that, according to the information available with me No. ......................... Rank
............................ Name .................................................. is serving in the Army/Navy/Air Force from
.................................................. and 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

Candidates furnishing certificate B as above will have to give the following undertaking :—
UNDERTAKING TO BE GIVEN BY THE CANDIDATE :
I understand that, if selected on the basis of the Recruitment/Examination to which this 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 Service and Posts) Rules, 1979, as amended from time to time.
Signature of Candidate
Station : ........................
Date : ...........................
(C) Form of Certificate applicable for serving ECOs/SSCOs who have already completed
their initial assignment and are on extended assignment.
It is certified that No. ........................ Rank ...................... Name .................................................
whose date of birth is ............................... is serving in the Army/Navy/Air Force from .........................
2. He/She has already completed his/her initial assignment of five years on ......................... and is
on extended assignment till .........................
3. There is no objection to his/her applying for civil employment and he/she will be released on
three months’ notice on selection from the date of receipt of offer of appointment.
Name and Designation of the
Competent Authority
SEAL
Station : ..........................
Date : ..............................

Authorities who are competent to issue certificate are as follows :—
(a) In case of Commissioned Officers including ECOs/SSCOs.
Army—Military Secretary Branch, Army Hqrs., New Delhi.
Navy—Directorate of Personnel, Naval Hqrs., New Delhi.
Air Force—Directorate of Personnel Officers, Air Hqrs., New Delhi.
(b) In case of JCO/ORs and equivalent of the Navy and Air Force.
Army—By various Regimental Record Officers.
Navy—BABS, Bombay.
Air Force—Air Force Records NERW, New Delhi.
(iv) A candidate who has claimed age relaxation and/or fee exemption on account of his being
physically challenged must submit a certified copy of the certificate issued by a Medical Board duly
constituted by the Central/State Government in the format given below :—

Form-I
APPLICATION FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS WITH
DISABILITIES
1.

Name

……………………….
(Surname)

…………………………..
(First name)

……………………………….
(Middle name)

2.

Father’s Name ……………………………….. Mother’s Name …………………………………..

3.

Date of Birth

4.

Age at the time of application : ……… Year

5.

Sex

6.

Address :

(a)

Permanent address

……….. /……………/………….
Date
Month
Year

Male / Female
(b)

Current address (i.e. for communication)

………….....…………………………

………………………………………………

………….........………………………

………………………………………………

…………………………………………

……………………………………………...

………………………………………...

………………………………………………

(c)

Period since when residing at current address

………………………………………………

7.

Educational status (Pl. tick as application)
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)

Post Graduate
Graduate
Diploma
Higher Secondary
High School
Middle
Primary
Illiterate

8.

Occupation

9.

Identification mark : (i) ………………………………. (ii) ………………………………

………………………………….

10.

Nature of disability : Locomotor/hearing/visual/mental/others

11.

Period since when disabled : From Birth/Since year ………………..

12.

(i) Did you ever apply for issue of a disability certificate in the past ……….

YES/NO

(ii) If yes, details :
(a) Authority to whom and district in which applied …………………………….
(b) Result of application
13.

………………………………………………………

Have you ever been issued a disability certificate in the past? If yes, please enclose a true copy.

Declaration : I hereby declare that all particulars stated above are true to the best of my knowledge and
belief, and no material information has been concealed or misstated. I further state that if
any inaccuracy is detected in the application, I shall be liable to forfeiture of any benefits
derived and other action as per law.

…………………………

Dated :
disabilities)
Place :

(Signature or left thumb impression of
person with disability, or of his/her legal
guardian in case of persons with mental
retardation, autism, cerebral palsy and
multiple

Encl :

1.

Proof of residence (Please tick as applicable)
(a) ration card,
(b) voter identity card,
(c) driving license,
(d) bank passbook
(e) PAN card,
(f) passport,
(g) telephone, electricity, water and any other utility bill indicating the address of
the applicant,
(h) a certificate of residence issued by a Panchayat, municipality, cantonment
board, any gazetted officer or the concerned Patwari or Head Master of a Govt.
school,
(i) in case an inmate of a residential institution for persons with disabilities,
destitute, mentally ill, etc., a certificate of residence from the head of such
institution.

2. Two recent passport size photographs
-----------------------------------------------------------------------------------------------------------------------(For office use only)

Date:
Place:

Signature of issuing authority
Stamp

Form - II
DISABILITY CERTIFICATE
(In cases of amputation or complete permanent paralysis of limbs and in cases of blindness)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
Recent PP size
Attested Photograph
(Showing face
only) of the person
with disability
Certificate No.

Date :

This is to certify that I have carefully examined Shri/Smt./Kum.
______________________________
Son/wife/daughter of Shri
__________________________________________________________________
Date of Birth ____________________ Age ___________________years,
male/female__________________
(DD/MM/YY)
Registration No. __________________ permanent resident of House No. ____________
Ward/Village/Street
__________________ Post Office __________________District __________ State
_________________,
whose photograph is affixed above, and am satisfied that :
(A)
he/she is a case of :
• Locomotor disability
• Blindness
(Please tick as applicable)
(B)
the diagnosis is his/her case is ………..
(C)
He/She has …………% (in figure)……………………. Percent (in words) permanent
physical impairment/blindness in relation to his/her ……………(part of body) as per guidelines
(to be specified).
2.
The applicant has submitted the following document as proof of residence:Nature of Document
Date of Issue
Details of authority issuing certificate

(Signature and Seal of authorized Signature of notified Medical Authority)
Signature/Thumb
impression of the
person in whose
favour disability
certificate is issued.

Form - III
DISABILITY CERTIFICATE
(In case of multiple disabilities)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
Recent PP size
Attested
Photograph
(Showing face
only) of the person
with disability

Certificate No.

Date :

This is to certify that we have carefully examined Shri/Smt./Kum. _______________________
______________________ son/wife/daughter of Shri __________________________________ Date of
Birth ____ _____ ____ Age ______ years, male/female _______ Registration No. _________________
( DD/ MM /
YY) permanent resident of House No. ________ Ward/Village/Street _____________
Post Office __________________District ____________ State _______________ whose photograph is
affixed above, and are satisfied that :
(A) He/She is a Case of Multiple Disability. His/her extent of permanent physical impairment/
disability has been evaluated as per guidelines (to be specified) for the disabilities ticked
below, and shown against the relevant disability in the table below:
Sl.
No.
1.

Disability

2.

Low vision

#

3.

Blindness

Both Eyes

4.

Hearing Impairment

$

5.

Mental retardation

X

6.

Mental-illness

X

Locomotor disability

Affected
Part of Body
@

Diagnosis

Permanent physical impairment/
mental disability (in %)

(B) In the light of the above, his/her over all permanent physical impairment as per guidelines
(to be specified), is as follows:In figures : ______________ %
In words : _________________________________________ percent
2.

This condition is progressive/non-progressive/likely to improve/not likely to improve.

3.

Reassessment of disability is :
(i) not necessary,
Or
(ii) is recommended/after ___ years ____ months, and therefore this certificate shall be
valid till _______ ______ __________
(DD)
(MM)
(YY)
@

e.g. Left/Right/both arms legs

#

Single eye/both eyes

$

Left/Right/both ears

4.

The applicant has submitted the following document as proof of residence:Nature of Document

5.

Date of Issue

Details of authority issuing certificate

Signature and seal of the Medical Authority.

Name and seal of Member

Signature/Thumb
impression of the
person in whose
favour disability
certificate is issued.

Name and seal of Member

Name and seal of the Chairperson

Form - IV
DISABILITY CERTIFICATE
(In cases other than those mentioned in Forms II & III)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
Recent PP size
Attested
Photograph
(Showing face
only) of the person
with disability

Certificate No.

Date :

This is to certify that I have carefully examined Shri/Smt./Kum. __________________________________
son/wife/daughter of Shri ____________________________________________ Date of Birth ____ _____ ____
( DD / MM / YY )
Age _____ years, male/female _______ Registration No. ___________________
permanent resident of House No. ______ Ward/Village/Street ______________ Post Office __________________
District _______________ State ____________________, whose photograph is affixed above, and am satisfied that
he/she is a case of _____________ Disability. His/her extent of percentage physical impairment /disability has been
evaluated as per guidelines (to be specified) and is shown against the relevant disability in the table below:
Sl.
No.
1.

Disability

2.

Low vision

3.

Blindness

4.

Hearing Impairment

$

5.

Mental retardation

X

6.

Mental-illness

X

Locomotor disability

Affected Part of
Body
@

Diagnosis

Permanent physical impairment/ mental
disability (in %)

#
Both Eyes

(Please strike out the disabilities which are not applicable.)
2.

The above condition is progressive/non-progressive/likely to improve/not likely to improve.

3.

Reassessment of disability is :
(i) not necessary,
Or
(ii) is recommended/after ________ years ________ months, and therefore this certificate shall be valid till
______ ______ ______
(DD)

@
#
$
4.

(MM)

(YY)

e.g. Left/Right/both arms legs
Single eye/both eyes
Left/Right/both ears

The applicant has submitted the following document as proof of residence:Nature of Document

Signature/Thumb
impression of the
person in whose
favour disability
certificate is
issued.

Date of Issue

Details of authority issuing certificate

(Authorised Signatory of notified Medical Authority)
(Name and Seal)
Countersigned
{Countersignature and seal of the CMO/
Medical Superintendent/Head of Government Hospital,
in case the certificate is issued By a medical authority
who is not a government servant (with seal)}

Note : In case this certificate is issued by a medical authority who is not a government servant, it shall be valid only
in countersigned by the Chief Medical Officer of the District.”
Note : The principal rules were published in the Gazette of India vide notification number S.O. 908(E), dated 31st
December, 1996.

11.
The candidates should note that their candidature for the Combined Medical Services
Examination, 2014 will be purely provisional, subject to their satisfying the prescribed eligibility
conditions. If on verification at any stage before or after the examination it is found that they do not fulfil
any of the eligibility conditions, their candidature for the examination will be cancelled by the
Commission.
12.
Enclosures to the application form to be sent to the Commission by the candidates are as
follows : —
(i) An attested/certified copy of the certificate of age.
(ii) An attested/certified copy of the certificate of educational qualification.
(iii) An attested/certified copy of certificate in support of claim to belong to Scheduled
Castes/Scheduled Tribes/Other Backward Classes (wherever applicable).
(iv) Undertaking by the candidate seeking relaxation as OBC candidates in support of claim not
belonging to creamy layer, to be given in format as mentioned in para B-1.
(v) An attested/certified copy of certificate in support of claim for age concession, wherever
applicable.
(vi) An attested/certified copy of certificate in support of claim to belong physically handicapped
(wherever applicable).
Originals of the above certificates are required to be produced at the time of interview.
NOTE :—Candidates are required to sign the attested/certified copies of all certificates sent along with
the printed copy of online application and also to put the date.

13.
Any application received without all or some of the enclosures will entail cancellation
of candidature. Any missing enclosures sent subsequently by the candidate will not be
entertained. The candidates must ensure that the printed copy of online application form is
properly filled in and is accompanied by all the relevant enclosures. No column of the printed
copy of online application should be left blank.
14. In all communications with the Commission regarding his/her application, the candidate
should mention the name of the Examination, his full name, Roll Number, Registration ID
(11 digits) and date of birth.
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