Annexure

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APPLICATION FOR THE POST OF CONSTABLE (GD) MALEiFEMALE AGAINST SPORTS OUOTA IN BORDER SECURITY FORCE 2016-17

(The application from should be filled neatly and legibly

block letiers. lt should be completed in all respects and should be accompanaed by certified copies ot testimonials lncomplete application will not be entertained).

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(lN BLOCK LEITERS)

1

Full Name

2

Father's Name

3

Religion i e Hindu/l\4uslim/Christian/ Sikh/Buddhist elc.

4.

Whether SC/ST/OBC/General

5.

Nahonality ( State whether by bi(h or Domicile).

6.

Date of birth ( in Christian era attach Certified copy of matrlculation/HR Secy or SSLC in support of age)

7

Educational Qualification

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Permanent Address

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Present Address

Paste here a coPY of your re.ent passport photosraph{

sne appx)

3.sx4.5

A

10.

Discipline of Game/event PlaYing

11.

Particulars of present employment lf any with post and service number/ Name of DePartment etc.

12

Details of Sports achievements

13

Details of criminal case, if any, pending/ lodged agaanst him in any police station/ Hon ble Courts of Law.

14

Value of IPO/Bank Drafl with Number & date

15

Lrst of enclosures

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DECLARATION are true' complete hereby declare that allstatements made in this application of any inlormation being and correct to the best of my knowledge and belief ln the event after the tesuinterview my found false or incorrect or inelagibility being deiected before or for the recruitment forfeited' I also candidature will stand cancelled and all my claims Board to have violated any of understand that if at any stage t am found by the selection process' my candidature can be the Rules/Regulation governing the conduct of selection board at its sole discretion' cancelled or 6e declared to have failed by the selection I do

Place: Date

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f

( Signature of Candidate

)

ANNEXURE-A ADMIT CARD APPLTCATION FOR THE POST OF CONSTABLE {GD) MAI.E/FF !A!:E AGAINST SPORTS OUOTA IN BORDER SECURITY FORCE 2016.17

(To be fitled in by the office)

Pasle here a copy of your recent passporl srze photograph

(appro)(.35x4.5

Roll No.

cms) duly altested

byaGO State

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Name ol candidate

2

Father's name

3

Date ot Birth

4

Postal address

5

WhelherGen/SC/ST/OBC

6

Name of the discipline (game)

(Srgnature of Candrdale)

TO AE FILLED BY OFFICE

1

Place of Reclt/Tesl

2

Date and ttme of reportrng

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Cenerat In,ormalon

4

lssued on

(Copy enclosed)

Sgnature wtlh Designation I Office seal ol Rec( Agency of BSF

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-lsAnnexure-'C' NO OBJECTION CERTIFICATE

through proper [Candidaie already in Government servrce must submit their application channel with the following certificate duly signed their employer agreeing to release them in case frnally selected for the post of Constable/GD against Sports quota in BSFI

1.

holds

Certitied that Shri/Kumari

a

permanenv

temporary post under Cenlral/ State Govt.

2.

Also certifaed that he/she has submitted his/her application to DepartmenVoffice

3

this

on-

Also certrfied that Shri/Kuman

will be relieved in

quota in BSF' case of his/her selection for the post of Constable/GD against sports

Place Date

Sionature of head of Off rcei Compelenl Authority wrlh name & Designation wlth Office Seal

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:----?

Annexure-'D' MEDICAL

F

NESS CERTIFICATE

(To be submitted only along with appeal for re-medical examination) Shri ... certify thal I have examined . )S/O, D/O Shri ...... ... ""' who has ...... . . (Roll No . . ...... in the recruitmenl been declared medically unfit due to .. ....

I Dr

oi CT GD against Sports quota in BSF After careful examinations and investigation, it is opined that

2

Shri

...

as

/ rs not suffering from

.

..

......

This candidate is given in full knowledge ol the fact that the candidate has already

been rejected being unfit for appointment by a Medical Officer'

(Signature of the candidate with Roll No. and name)

Signature of medical Officer (With name and seal)

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Registration No (MCUSlate Medical Council) Address

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t_

-t+ Annexure FORM OF APPLYING

CED BY OTH

FICATE TO BE F

T UNDER TH

APPOINTIMENT T

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F

CKWARD CLAS ERNMENT son/daughter

This is lo certify that Shri/Smt/Kumari

villaqe/town

of

oi

in

DistricUDivision

ln the State/Union TerritorY

CommLrnity which

belonqs to the

as

recognized

as a backward class under the Governmenl of lndia, Ministry of Social Justice and Empowermenl's

No.

Resolution

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Shri/Smt/Kumari

dated

and/or his/her DislricUDivision of

family ordinarily reside(s) in lhe

Stale/Union Territory. This is also to certify that he/she does nbot belong to the persons/sections (Creamy Layeo mentioned in Column 3 of the Scheduled to the Government of lndia. Department of Personnel & Traininq O M No' 3601 2i22l93-Estt(SCT) dated 8.9.

1

993'.

District Magistrate Deputy Commissioner etc

Dated: Seal

-The authority issuing the certificate may have to mention the details.of Resoultion of Government of lndia in which the caste of the candidate"s is mentioned as oBC' "As amended from time to time. 20 of the Note : The term "Ordinarily"used here witll have the same meaning as in section Representation of the People Act '1950

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t3,

Annexure

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FORM OF CERTIFICATE TO BE SUBMITTED BY THO9E - gANP-I_DATES WHO ttttettO tO ltrtlL neLlXAttOtt tH XetGHt On CgeSt UEISUneMEXt S/O Shri

Cerlified that Shri

permanent

resident district

It is further certified that

.

village

Tehsil/Taluka State.

:

Candidates falling in the categories of Garhwalis, Kumaonis, Dogras, Marathas and candidates belonging to the States of Assam, Himachal Pradesh and Jammu & Kashmir Candidates hailing from the North Easlern States of Arunachal Pradesh' Manipur, Meghalaya, Mizoram, Nagaland, Sikkim & Tripura and candidates hailing from 6orkha Territorial Adminstralion (GTA) comprising of the three Sub-d-lvisions of Darieeling District namely Darjeeling, Kalimpong and Kurseonq and includes the following "Mouzas" Sub division of these districts (1)Lohagarh Tea Garden (2) Lohagarh Forest l3)- Rangmohan , (4) 'BaraJhenga (5) Panighata (6) Chota Adalpur (7) Paharu (8) Sukna Forest (1r) ihampaslri Forest (13) Salbari Chhat part-ll (14)-Sitong forest ilsi Sivoke Hill Foresl (16) Sivoke Forest (17) Chhota Chenga (18) Nipania. He /She belong to Scheduled Tribe.

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Signature

District Llagistrate/Sub -Division Magistrate /Tehsildar Date P

lace:

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Delete whichever is not applicable