IDENTITY CERTIFICATE

Attested photo

Certificate to be signed by one of the following:-

(i) Gazetted Officers of Central or State Government ;

(ii) Members of Parliament or State Legislature belonging to the constituency where the candidate
or his ordinarily resident ;
(iii) Sub-Divisional Magistrates/Officers ;
(iv) Tehsildars or Naib/Deputy Tehsildars authorised to exercise magisterial powers ;
(v) Principal/Head Master of the recognized School/College/Insitution where the candidate studied
last ;
(vi) Block Development Officers ;
(vii) Post Masters ;
(viii) Panchayat Inspectors.

Certified that I have known Shri/Smt./Kumari …………………………………………………….. son/daughter

of Shri……………………………………………… for the last ………… years ………….. months and that to the best of
my knowledge and belief the particulars furnished by him/her are correct.

Signature ……………………………….
Place ……………………… Designation or
Status and address
Date ……………………….

(To be filled by the Office)

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(i) Name, designation and full address of the
appointing authority

(ii) Post for which the candidate is being considered

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 ATTESTATION FORM

E.N. No…………….. Post ………….………..

Category No………... Roll No………………..

WARNING: - (1) The furnishing of false information or suppression of any factual information in the
Attestation Form would be a disqualification, and is likely to render 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 Railway Recruitment Board
or the authority to whom the
Affix signed passport size Attestation Form has been sent earlier, as the
Copy of recent photograph case may be, failing which it will be deemed to
be a suppression of factual information.

(3) If the fact that false information has been furnished

or that there has been suppression of any factual
information in the Attestation Form comes to
notice at any time during the service of a person, his
service would be liable to be terminated.
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1. Name in full (in block letters) with alias, if any. Surname Name
(Please indicate if you have added or dropped in
any stage any part of your name or surname)

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2. Present address in full (i.e.,Village, Thana and
District or House Number, Lane/Street/Road
and Town)

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3. (a) Home address in full (i.e.,Village, Thana
and District or House Number, Lane/
Street/Road and Town and name of
District Headquarters)

(b) If originally a resident of Pakistan, the address

in that country and the date of migration to
Indian Union.
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4. Particulars of places (with periods of residences) where you have resided for more than one year at
a time during the preceding five years. In case of stay abroad (including Pakistan) particulars of all
places where you have resided for more than one year after the age of 21 years, should be given:
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From To Residential address in full Name of the District
(i.e.,Village, Thana and Headquarters of the
District or House Number, Lane/ place mentioned in
Street/Road and Town) the preceding column
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Name in full Nationality Place of birth Occupation Present
Permanent
With aliases (by birth (if employed Postal Address Home
If any and/or by give desig- (if dead, give address
Domicile nation and last address)
Official
Address.
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5.(i)Father
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(ii) Mother
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(iii) Wife/Husband
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(iv) Brothers (i)
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(ii)
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(iii)
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(iv)
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(v)
(v) Sisters (i)
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(ii)
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(iii)
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(iv)
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(v)
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(a)Information to be furnished with regard to son(s) and/or daughter(s) in case they are studying/living
in a foreign country:-
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Nationality Place of birth Country in which Date from
Name (by birth and/ studying/living which studying/
Or by domi- with full address living in the
Cile) country
mention
Ed in the previ-
Ous column.
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6. Nationality

7. (a) Date of birth

(b)Present age

(a) Age at Matriculation

8. (a) Place of birth, District and State in which situated

(b) District and State to which you belong

(c) District and State to which your father originally belonged.

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9. (a) Your religion

(b) Are you a member of a Schedule Caste/Schedule

Tribe? Answer "Yes" or "No" and if the answer
Is "Yes", state the name thereof
10. Educational qualifications showing places of education with years in Schools and Colleges since 15 th
year of age
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Name of School/College with full adress Date of Date of Examination passed
Entering leaving
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11. (a) Are you holding or have any time held an appointment under the Central or State Government or
a semi-Government or a Quasi-Government body, or an autonomous body, or a public undertaking,
or a private firm or institution? If so, give full particulars with dates of employment up-to-date:
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Period Designation, emoluments and Full name and address
Reasons for
------------------------- nature of employment of employer
previous service
From To
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11. (b) If the previous employment was under the Government of India, a State Government/an
undertaking owned or controlled by the Government of India or a State Government/an
autonomous body/University/Local body:

If you had left service on giving a month's notice under Rule 5 of the
Central Civil Service (Temporary Service) Rules, 1965, a notice for the
Prescribed period under Rule 149 of the Indian Railway Establishment
Code, Volume I, or any similar corresponding rules, were any disciplinary
Proceedings framed against you, or had been called upon to explain your
Conduct in any matter at the time you gave notice of termination of
Service, or at a subsequent date, before your services actually terminated?
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12. (i) (a) Have you ever been arrested? YES / NO

 (b) Have you ever been prosecuted? YES / NO

(c) Have you ever been held under Police custody? YES / NO

(d) Have you ever been bound down? YES / NO

(e) Have you ever been fined by a Court of Law? YES / NO

(f) Have you ever been convicted by a Court of Law for any offence? YES / NO

(g) Have you ever been debarred from any examination or rusticated by any
University or any other educational authority/institution? YES / NO

(h) Have you ever been debarred/disqualified by any Railway or Public Service
Commission for any of its examinations/selections? YES / NO

(i) Is any case pending against you in any Court of Law at the time of filling up
this Attestation Form? YES / NO

(j) Is any case pending against you in any University or any other educational
authority/institution at the time of filling up this Attestation Form? YES / NO
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(ii) If the answer to any of the above mentioned question is 'Yes', give full particulars
of the case/arrest/detention/fine/conviction/sentence/punishment, etc. and/or the
nature of the case pending in the Court/University/Educational Authority etc. at
the time of filling up this form.

Note:- (i) Please also see the "Warning" at the top of this Attestation Form.
(ii) Specific answer to each of the questions should be given by striking out 'Yes' or 'No' as the
case may be.

-13. Names of two responsible persons of your locality (1)

and address or two references to whom you are known

(2)
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I certify that the foregoing information is correct and complete to the best of my knowledge and
belief. I am not aware of any circumstances which might impair my fitness for employment under
Government.

Signature of Candidate …………………………………………..

Place …………………………………………..
 Format of Affidavit sworn before first class executive Magistrate
I Sri/Smt/Kumari________________Son/Daughter of Sri________________
aged ___ years ____________Resident of
At____________TQ____________Dist__________Pin______ (give complete
residential address) have been allowed to appointment “Fresh Entrant” for the
post of Junior Engineer in Mechanical Department without any claims what so
ever at a later date,
a. I will not claim/come up with a further request for continuance/counting
my past service for any purpose, under any circumstances,
b. My appointment being a fresh entrant and also well aware that I am
governed only by “ New Pension Scheme” and not governed by“ Railway
Services (Pension) Rules-1993 and hence will not be eligible for any
pension etc under this rule an account of your previous service
c. I am also well aware that, none of the benefits are eligible in respect of my
past service, and I will not claim any such benefits in future viz. Pass, leave
etc.
d. I can be considered for absorption as Helper after prescribed satisfactory
period of continuous service subject to availability of regular vacancies in
this Railway.
Any pending detailed verification of character and antecedents have
submitted a character certificate from principal of the educational Institution I last
attended/ Gazetted officer (delete whichever is not applicable) for simple
verification of my character and antecedents here by certify that I have no
adverse report with the police authorities anywhere in India or aboard and have
not criminal case/pending against me nor have I been convicted in any criminal
case in the past.
In case any adverse report about my character and antecedents is
later given by the police/civil authorities, the administration of the South Western
Railway will be well within their right to terminate my training/Service and cancel
my candidature for the post of Junior Engineer in Mechanical Department
forthwith.

Signed this_________ day of ________month of _______year

Signature of the candidate

Full Address
 Character Certificate

Certificate to be signed by a Gazetted Officer of a Central or State Government.

Certified that I know smt/sri ............................................. daughter/son of

Shri ............................................. for the last ......... years and that to the post of my
knowledge and belief, she/he bears a good moral character and that there is nothing to
disqualify her/him for being employed in Government service.

Place: Signature
Date:

Character Certificate

Certificate to be signed by a Gazetted Officer of a Central or State Government.

Certified that I know smt/sri ............................................. daughter/son of

Shri ............................................. for the last ......... years and that to the post of my
knowledge and belief, she/he bears a good moral character and that there is nothing to
disqualify her/him for being employed in Government service.

Place: Signature
Date:
(To be signed by the Head of Educational Institute last attended and similar certificate
the employer, if any).

ATTESTED

Place: Signature
Date: Designation
(Attesting Authority)
(To be attested by stipendiary First Class Executive Magistrate/District or Sub-Divisional
Magistrate)

NOTE:- It should be specifically noted that the seal of the same office of the Gazetted
Officer signing should be failing which you are liable to be rejected for appointment.
 DEED OF INDEMNITY
SPECIAL ADHESIVE STAMP
BEFORE FILLING THE FORM

This Deed of Indemnity made this …… day of ………. 200 by Shri………………….. son
of Shri…………………………… residing at ……………. …………………… (Hereinafter referred
to as 'TRAINEE' which expression shall include his heirs, executors, administrators and
representatives where the context so admits) and Shri…………………. Son of
……………………………….. residing at ……………………… (Hereinafter referred to as
'SURETY' which expression shall include his heirs, executors, administrators of SOUTH
WESTERN RAILWAY (hereinafter referred to as 'THE GOVERNMENT') of the OTHER PART.

WHEREAS the Government has engaged the trainee on the terms and conditions
mentioned in the joining report dated …………… executed by and between the Trainee and the
Government.
AND WHEREAS the Surety is interested in the welfare of the said trainee and therefore
has agreed to these present as a Surety.
AND WHEREAS one of the terms and conditions to the said engagement of the Trainee
is that the trainee shall complete the prescribed training and after such completion shall accept
service under the government and serve the Government for a minimum period of five years
and if the trainee desires to serve or resigns from the service during the period of training or
thereafter without the written consent of the Government or is discharge there from for
misconduct or any other offence, the trainee shall repay on demand by the Government the
whole cost of training or pay any other amounts, excluding Travelling and running allowance
drawn by the trainee from the Government under these terms and conditions.
AND WHEREAS the SURETY has agreed to Indemnity and/or to reimburse to
Government to that extent.

NOW THESE PRESENTS WITNESS and it is hereby agreed by and between the
parties as follows:-

1. That in consideration of the premises and in consideration of the Government agreeing

to engage the trainee for the course mentioned in the joining report referred to above,
the trainee after completing the training satisfactorily, shall serve the Government for a
minimum period of five years thereafter in accordance with the said joining report
executed between the Trainee and the Government to the complete satisfaction of the
Government. (Decision of the Government about which shall be final and conclusive).

2. That the Trainee and the Surety hereby undertake jointly and severely to indemnity and
reimburse the Government to that extent as aforesaid.

3. That in the event of Trainee getting adverse report regarding the progress of his training,
of studies or conduct or on discontinuing his studies or being discharged from the course
or on refusal to continue for any reasons not beyond the control of the trainee or doses
not continue in service as aforesaid, the trainee and the surety shall jointly and severely
be liable to pay and refund forthwith to the Government on demand and without demur in
cash all money expended.
On the Trainee or on his account in respect of his training course as stated above and
the decision of the Government as to the amount so payable shall be final together with
interest on the said moneys calculated at the rate then in force for Government loans.
4. That the liability of the Surety hereunder shall not be impaired or discharged by reason
of time being grant or any for aberrance act or omission of the Government or any
person authorized by the Government (whether with or without the knowledge of
..2..
the Surety), nor shall it be necessary for the Government to sue the trainee before suing
the Surety for the amount due hereunder:-

…………………………….. …………………………………

Signature of the Trainee Signature of the Surety

5. That if there is any dispute as to the effect or meaning of these presents or otherwise,
however, except as to matters for which specific provision has been made in these
presents, the same shall be referred to the sole arbitration of the Secretary to
Government of India in the Ministry of Railways or any person appointed by him whose
decision shall be final and binding on the parties. The provisions of Indian Arbitration
Act 1940, as amended from time to time shall apply.

IN WITNESS THERE OF, the parties have set their hands on the day and year first
mentioned above.

WITNESS FOR TRAINEE TRAINEE

1. Signature Signature

Name and address Name

Date: Date:

2. Signature

Name and address

Date:

WITNESS FOR SURETY SURETY

1. Signature Signature

Name and Name and

Address Address

Office and
Place
2. Signature

Name and
Address
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 CERTIFICATE REGARDING PAY OF SURETY

This is to certify that the gross salary of Shri………………………………………… who is

working as ……………………………………… in the office of ……………………………… is
Rs……………..

Signature:

Designation:
OFFICE SEAL Date: