ATTESTATION FORM
Warning:
1. Furnishing of false information or
suppression of any facts in
this attestation form would make the
candidate unfit for
employment under the Government.
2. If detained, convicted, debarred etc., subsequent to the
completion and submission of this form the details should be
communicated immediately to the Union Public Service
Commission or the authority to whom the attestation form has
been sent earlier as the case may be, failing which it will be
deemed to be suppression of factual information.
If the fact that false information has been furnished, or that there has been suppression of any
fact and information in the attestation form, comes to notice at any time during the service of the
person, his service would be liable to termination.
1. Name in full ( In Block letters) Surname Name
with aliases, if any:
( Please indicate if you
have added or dropped in any
state any part of your name
or surname)
2. Present Address in Full:
(i.e. Village, Thana & District,
House No. Lane/Street/Road,
And Town):
3.a) Home Address, in Full
(i.e. Village, Thana & District,
House No. Lane/Street/Road,
And Town):
b) If, originally a resident of Pakistan,
The address in that country and the
Dated of migration to Indian Union
May be furnished:
________________________________________________________________________________
4. Particulars of place (with period of residence) where you have resided for more than one
year at a time during the preceeding five (5) years. In case of stay abroad (including Pakistan)
particulars of all places where you have resided for more than one year after attaining the age of
21 years should be given:
From To Residential address in full (i.e. Name of the District Headquarters
Village, Thana & District, House No. of the place mentioned in the
Lane/Street/Road, and Town preceeding column
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5. a) Father’s name in full with
aliases, if any:
b) Present Postal address,
If dead, give last address:
c) Permanent Home address:
d) Profession:
6. Nationality of :
a) Father:
b) Mother:
c) Husband/Wife:
d) Candidate:
e) Place of birth of husband/wife:
________________________________________________________________________________
7.a) Date of Birth of the candidate:
b) Present age of the candidate:
c) Age at Matriculation of the candidate:
________________________________________________________________________________
8.a) Place of birth, District/State in which situated:
b) District and State to which you belong:
________________________________________________________________________________
9.a) State your Religion:
b) Are you a member or SC/ST/OBC?
Answer ‘Yes’ or ‘No’ and if the answer is ‘Yes’
State the name thereof :
________________________________________________________________________________
10. Educational qualification showing places of education with years in School and Colleges
since 15th year of age.
Name of School/College with full address Date of Date of Examination passed
entering leaving
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11.a) Are you holding or have any time held appointment under the Central or State
Government, Semi or Quasi Government body or Public undertaking or Private firm or
institution, if so give particulars with date of employment upto date:
From To Designation & Nature Full Name & Address of the Records for
of Employment Employee bearing of
previous service
b) If the previous employment was under the Govt. of India/State Govt. undertaking owned
or controlled by the Govt. of India or State Govt./Authorised body/University/Local body.
If you have left service on giving a month’s notice under Rule 5 of CCS(T8) Rules 1965 or
any similar correspondence rules whether any disciplinary proceedings have been drawn
against you and a notice for termination from service was issued or actually terminated?
________________________________________________________________________________
12.a) Have you ever been arrested, prosecuted, kept under detention or bound down,
convicted by a court case of law for any office or Department/disqualified by the Public
Service Commission, from appearing at its examination or barred from taking examination
restricted by any University or any other educational authority/Institution?
b) If any case is pending against you in any Court of Law/ University or any other Educational
Institution at the time of filling up of this attestation form:
If the answer to 12. a) and b) is ‘Yes’ full facts of the case, arrest, detention, fine, conviction,
sentence etc. and the nature of pending case at the Court/University/Educational authority etc. at
the time of filling up this form should be given:
________________________________________________________________________________
13. Name of Two responsible persons of your locality to whom you are known (with full
address)
a)
b)
________________________________________________________________________________
I certify that the foregoing information is correct and complete to the best of my
Knowledge and belief. I am aware of any circumstances which might impair my fitness for
employment under Government.
Date:
Place: Signature of the Candidate
Certificate to be signed by the gazetted officer or MLA or other authority prescribed by the
appointing authority.
Certified that I have known Sri/Smt____________________________________________
S/o, D/o/W/o_______________________________ of village____________________________
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Signature
DESCRIPTIVE PARTICULARS AND DECLARATION OF THE
CANDIDATE
1. Name:
2. Father’s Name:
3. Date of Birth:
4. Nationality & Caste:
5. Educational Qualification:
6. Permanent Address:
7. Present Address:
8. Exact height:
9. Particulars of landed property:
10. Income from other sources:
11. Personal Mark of Identification:
12. Impression of five fingers:
Signature of the Candidate
Attested by:
DECLARATION
1. I do hereby declare that I have read/has been explained to me the Government Servant
Conduct Rules and thoroughly understand them.
2. I do hereby believe that I have read/has bee explained to me the Govt. of India orders
conveyed in the Deptt. Of communication (P&T) letter No. F1-85/12A dtd. 09.5.41
addressed to the DG P&T and thoroughly understand them.
3. I do hereby believe that I have read/has been explained to me the Rule 103 of P&T
Manual Vol II its upto date changed as noted from time to time correction thereof.
Signature of the Candidate
Attested by:
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HEALTH CERTIFICATE
I Dr_____________________________________________ do hereby
certify that Sri/Smt./Miss_________________________________________ a
candidate for employment in the Indian Postal Department
as___________________________________________________has been
examined by me and that he/she is not suffering from any disease
(communicable or otherwise), constitutional weakness or bodily deformity
except_____________________________
I do not consider this a disqualification for employment in the Post
of____________________________________________
Signature
Dated:
Designation of
Medical Officer.
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CHARACTER CERTIFICATE
Certified that I have known Shri/Smt _______________________________ son/daughter
Of Shri _____________________________resident of _______________________for the
Last _________years __________months and that to the best of my knowledge and belief
He/she bears reputable character and has no antecedents which render him unsuitable
for Government employment.
Signature :
Designation :
Place_____________
Date_____________
( To be attested by stipendiary I class Executive Magistrate, District Magistrate or Sub
Divisonal Magistrate )
Attested
Place : Signature
Date : Designation
