COVID-19 SELF DECLARATION FORM

(To be submitted by the Candidate)

I hereby declare that I haven’t been tested positive for Corona Virus or
identified as a potential carrier of COVID-19 virus and I am also not having any of
the symptoms related to COVID-19.

2. I further declare that I will strictly adhere to the guidelines prescribed by the
Government, in this regard.

Name of the Candidate : ………………………………………………………

Application Number. : ………………………………………………………

Name of the Post : ………………………………………………………

BARC Advertisement No. : ………………………………………………………

Date of Examination : ………………………………………………………

Name & address of the ………………………………………………………

examination Centre :
………………………………………………………

Signature of the :
candidate with date