HIMACHAL PRADESH PUBLIC SERVICE COMMISSION

ATTESTATION FORM

Attestation Form for Candidates applying for recruitment by selection

Advt. No.………...………..Name of Post……………….………...…………………..Item No………………

WARNING

1. Furnishing of false information or suppression of any information would

Paste recent
(last six months period)
Passport size attested
Photograph
be a disqualification for examination and if appointed the service would be
liable for annulment.
2. If detained, convicted, debarred etc. subsequent to the completion and
submission of this form, the details should be communicated immediately to
the Himachal Pradesh 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 a suppression of material information.

1 Name in full (in block capital), with

aliases, if any (Please indicate if you have
added or dropped at any stage, any part
of your name or surname).
2 Present address in full (i.e.
Town/Village, Thana, Tehsil and
District) with Pin code.

3 Telephone Number (Landline)

4 Mobile Number

5 E-mail ID (If any)

6 Permanent home address in full (i.e.
Town /Village, Thana, Tehsil & District)
with Pin code.
7. Academic Qualifications---from Matriculation onwards:
Sr. Examination % age of Year of
No. Passed Marks Passing Board/University Subjects

8. Details of family members i.e. spouse, father, brother, sisters, sons/daughters:

Name Age Present occupation including designation

9. Hobbies:

10. Notable achievements and failures made in studies:

11. Notable achievements made in sports / extra-curricular activities:

12. Place visited (also mention stay outside home place or ordinary place of residence where the
applicant stayed for six months or more after the age of 15 years).

13. Self assessment (write briefly why should you be selected for the post):

14. Give Chronological detail of your employment:

Sr. Name of Deptt./ Post held From To Whether Remarks/reasons for

No. Company Permanent/ leaving previous
Temporary/Tenure service

15. Particulars of places including foreign countries (with period of residences) where you have resided for
more than one year at a time during the preceding five years:

From To Residential Name of the District headquarters of the

address in full place mentioned in the preceding column

16. Nationality … …….. ………………………….

17. (a) Date of birth (In Christian era) … …….. ………………………….

(b) Present age … …….. ………………………….

18. (a) Do you belong to any prescribed reserved
category of Himachal Pradesh?

(b) If the answer is “Yes” state the category

19. (a) Have you ever been arrested or kept under detention?
If “YES” give details.

(b) Have you ever been disqualified, debarred from

appearing in any examination? If “YES” give details.

(c) Have you ever been bound down/fined or convicted

by any court? If “YES” give details.

(d) Is any case pending against you in any court or Law University
or any Other educational authority/Institution at the time of filling
this attestation form? If “YES” give details.

20. Names and Addresses of the two responsible persons of your locality or two references to whom you are
known.

1. …………………………………………………………………………………

…………………………………………………………………………………

2. …………………………………………………………………………………

………………………………………………………………………………….

I certify that the forgoing 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.

Date: …………………. (Signature of candidate)

Place: …………………
 IDENTITY CERTIFICATE

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

(This certificate may be signed by the same authority which has attested the photograph of the
candidate).

Certified that I have known Shri/Shrimati/Kumari………………………………………………

Son/daughter of Shri………………………………..from the last …………….years……………months

and that to the best of my knowledge and belief the particulars furnished by him/her are correct.

Place: …………….. Signature……………………

Date: ……………… Designation or status and address.