Proforma 1 : Details of Persons/Invigilators on Examination Duty (&Underatking)

(to be Maintained by Centre Head for every Invigilator and to be verified by Observer)

Name of the Examination:

Centre Name: Centre Code:

Personal Details

S. No. Name and Address of the Highest Photograph Govt Id Details

Invigilator/Person on Duty Qualification

Duty Details ((Strike empty rows)

Dates of Duty Shift of Duty Signature Remarks

I……………………………………………. hereby declare that none of my dependent or near relative is /are

appearing in the above-mentioned examination at the above Centre. I further declare -

Signature of the Invigilator/Person on Duty

It is to certify that all Invigilators deputed at this Centre are qualified professionals and can brief the
instruction to the candidates. They have been explained about their roles and responsibilities, and
confidentiality associated with the assignment.
Name and Signature of Centre Head/TCA
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