You are on page 1of 9

MET-2011/PAM-CAT-2011

ANNEXURE-4 SPECIMEN OF CERTIFICATES For the purpose of uniformity for issuing the certificates of residence in the case of various categories to be issued by the Competent Authorities, the Performas have been prescribed which are enclosed herewith. After careful consideration, it has also been decided to delete the D.T.O. included among the certifying authorities against category (iv) and (v) of the policy instructions dated 29.01.1996.

Affidavit of the Parents/Guardian (Compulsory for All Candidates)
Affidavit to be attested by an Executive Magistrate/Oath Commissioner/Notary Public in Case of Category- a and b (Annexure-3) I father/mother/guardian of Miss/Mr _______________resident of ___________________ (full address to be given) do hereby solemnly state and affirm as under: That I am a citizen of India Neither I, nor my children/ward/dependent have obtained the benefit of residence in any other State (or any other standard language approved by the Punjab Govt.) Dated: Deponent

Verification Verified that the contents of my above affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed thereof. Dated: Deponent

RESIDENCE CERTIFICATE
To be issued by the Principal/Headmaster of the Government/Recognized School/College concerned in case of Category- (i)

It is certified that Miss/Mr. D/o, S/o Sh. this School/College for a period of year, from . He/she left the School/College on

has been a student of to .

Dated:

Signature of Principal/Headmaster of the School/College (with seal)

RESIDENCE CERTIFICATE
To be issued by the Head of the Department in case of Category-ii (a)

a) Certified that Shri S/o Shri father of Miss/Mr. (Name of the Child/Ward) is an employee of (Name of the office) of Punjab Government. He/She has more than three years service at his/her credit. OR b) Certified that Shri S/o Shri father of Miss/Mr. is an employee of Punjab Government. He/She is working on deputation with the and is posted at He/She has more than three years service at his/her credit. Place: Dated: RESIDENCE CERTIFICATE
To be issued by the Respective Head of the Department in case of Category-ii (b)

Head of Department (with seal)

Certified that Shri S/o Shri father of Miss/Mr. is an employee of Govt. of India and is working as . He has been posted at Chandigarh/Punjab in connection with the affairs of Punjab Government for the past three years.

Dated:

Head of Department (with seal)

RESIDENCE CERTIFICATE
To be issued by the Respective Head of the Department in case of Category-ii (c)

Certified that Shri S/o Shri father of Miss/Mr. is an employee of Govt. of Punjab (State Government/Institution/ Undertaking and is working as . He is posted at Chandigarh/Punjab in connection with the affairs of Punjab Government for the past three years.

Dated:

Head of Department (with seal)

39 RESIDENCE CERIFICTATE
To be issued by Respective the Head of the Department in case of Category-ii (d)

Certified that Shri S/o Shri father of Miss/Mr. is an employee of in which the punjab Government has (name of autonomous body/company) 20% or more share. He/She is working as and is posted at It is also certified that he/she has three years service in the above autonomous body/company.

Dated:

Head of Department (with seal)

RESIDENCE CERIFICTATE
To be issued by the DC, ADC(R), ADC(D), SDO(C), GA TO DC, DORG, DRO, DM, Tehsildar, Commissioners of Municipal Corporation of Amritsar, Jalandhar and Ludhiana in Case of Category- (iv)

Certified that Shri S/o Shri father/guardian of Miss/Mr. (name of the child/ward with full address) has settled* in Punjab or has resided* in Punjab for a period of 5 years from to . He is working as * Strike whichever is not applicable. Dated: Signature(with seal)

RESIDENCE CERIFICTATE
To be issued by the DC, ADC(R), ADC(D), SDO(C), GA TO DC, DORG, DRO, DM, Tehsildar, Commissioners of Municipal Corporation of Amritsar, Jalandhar and Ludhiana in Case of Category - (v)

Certified that Shri S/o Shri (Name of persons) father/guardian of Miss/Mr. (Name of the child/Ward with full address) hold an immovable property at in the State of Punjab for the past years. Dated: Signature(with seal)

40 RESIDENCE CERIFICTATE
To be issued by the DC, ADC(R), ADC(D), SDO(C), GA TO DC, DORG, DRO, DM, Tehsildar, Commissioners of Municipal Corporation of Amritsar, Jalandhar and Ludhiana in Case of Category-(vi)

Certified that Miss/Mr. D/o, S/o. Shri born in Punjab as per Birth Certificate. Dated:

resident of Signature(with seal)

was

SCHEDULED CASTE/TRIBE CERTIFICATE To be issued by the District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/ Additional Deputy Commissioner/Deputy Collector/First Class Stipendary Magistrate/City Magistrate/Sub Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner (not below the rank of Ist class Stipendary Magistrate), Revenue Officer not below the rank of Tehsildar. 1. It is certified that Shri/Smt./Kumari Son/daughter of Shri. of village/town District/ Division State of Punjab belongs to caste which has been recognized as Scheduled Caste as per “ The Constitution Scheduled Castes Order 1955”. Shri/ Smt./Kumari and his/her family lives in village/town District/Division of Punjab State. Signature(with seal) BACKWARD CLASS CERTIFICATE To be issued the Sub Divisional Officer(C)/Executive Magistrate/Tehsildar/Naib Tehsildar/ Block Development Officer/District Revenue Officer/M.L.A. of the concerned constituency. 1. This is to certify that Shri/Smt./Kumari Son/daughter of Shri of village/town_ in District/Division of State of Punjab belongs to the caste which is recognized a Backward Class in terms of Punjab Government Letter No. Dated _________________________________. 2. This is also certified that he/she does not belong to any category of persons/sections mentioned in column 3 of the Schedule of Punjab Government, Department of Welfare Letter No. 1/4/93-RCI/459, dated 17-1-1994 and No8/144/93-BS2/7017, dated 27-9-95. Shri/Smt./Kumari village/town Punjab. and/or/his/her family of District/Division ordinarily reside(s) in of the State of

2.

Dated: Place:

3.

Dated: Place:

Signature(with seal)

CERTIFICATE FOR FREEDOM FIGHTER
Certificate for being Children/Grand Children of Freedom Fighter

(Grand Children would mean Son’s Son/Daughter or Daughter’s Son/Daughter) Dispatch No. Certified Date:

that son/daughter of Shri of village P.O. Tehsil District has been granted freedom fighter’s pension by the Punjab Government or has been awarded Tamra Patra for his/her political sufferings.

*Deputy Commissioner (with Seal of the Court) *Certificate from no other authority will be accepted

BACKWARD AREA CERTIFICATE Dispatch No. Date:

son/daughter of Shri is a bonafide resident of which has been declared as backward area by the Punjab Government. His/Her claim falls under Category* indicated below:
*a)

Certified that

b)

a person who with the family members has been residing in particular village or town/included in the list of areas which are declared backward constantly for a period of ten years or more and is likely to continue to reside there. a person who has been residing in a village/town for a period of less than ten year but not less that five years who is likely to reside there on account of the fact that he has obtained employment and will settle there after retirement. In case of a person who has been residing in a village or town included in the list of areas which are declared backward and has migrated to another village or town in the said area, the total of his stay at both places will be counted.

Dated: Sub-Divisional Officer (Civil) (With seal of the court)

**District Magistrate/G.A. to D.C.

*Please mention here category (a) or (b) as the case may be **Certificate from authority other than D.M./G.A. to D.C. or S.D.O.(Civil) is not valid.

DEFENCE/PARA-MILITARY/PUNJAB POLICE/PAP/PUNJAB HOME GUARDS PERSONNEL CERTIFICATE To be obtained from the appropriate authority with dispatch number and date of issue along with seal of the officer issuing the certificate mentioned in the Prospectus for the category. Certificate must indicate the name of the candidate CERTIFICATE OF DEATH/INCAPACITATION OF MILITARY/PARA-MILITARY PERSONNEL
Dispatch No. Date:

Certified that Mr./Ms. an applicant for admission to MBA/MCA course, is the son/daughter/spouse of Mr./Ms. who was killed/incapacitated to the extent of 50% or more in action or died otherwise in service or incapacitated to the extent of 50% or more while in service during peace time.

Dated:

Signature Authorized Officer Headquarter Official Seal CERTIFICATE TO BE FURNISHED BY WARDS OF MILITARY/PARA-MILITARY (EX-SERVICEMEN)
Date:

Dispatch No.

This is certified No. Name and has served

in

the

Rank is a resident of village/town Indian Armed Forces from dated or

to

and has been released/retired vide order No. discharge certificate issued by is an ex-serviceman.

Mr./Miss/Smt. wife/son/daughter of is residing with him and is wholly dependent upon him. This certificate has been issued for admission purpose only to Mr./Miss/Smt to apply for (name of the class course) in (name of the educational institution) . (Strike out which is not applicable) Deputy Director Sainik Welfare Place:

CERTIFICATE TO BE FURNISHED BY WARDS OF MILITARY/PARA-MILITARY PERSONNEL (IN-SERVICE) Certified that Mr./Mrs. Son’s/daughter’s an applicant to MBA/MCA course is a son/daughter or son/daughter/spouse of . Signature of Commanding Officer of the Unit Official Seal Mr. Rank

employed in Unit Dated:

CERTIFICATE OF ARMY DESERTERS AFTERMATH OPERATION BLUE STAR
Dispatch No. Date:

Certified that Mr./Ms. MBA/MCA course, is the son/daughter/spouse of Mr./Ms. deserted the Army Aftermath of Operation Blue Star.

an applicant for admission to Rank who

Place:

Deputy Director Sainik Welfare Dated: CERTIFICATE OF GALLANTRY AWARD TO POLICE PERSONNEL

Dispatch No.

Date:

Certified that Mr./Ms. MBA/MCA course is the son/daughter/spouse of Sh. Presidents’s Police Medal for gallantry.

applicant for admission to who was awarded

Dated:

Signature of Inspector General of Police Official Seal

FORMAT OF DEATH CERTIFICATE TO BE ISSUED BY THE CONCERNED SUB DIVISIONAL OFFICER(CIVIL) IN RESPECT OF INNOCENT CIVILIANS KILLED/100% PHYSICALLY INJURED BY TERRORITS/SECURITY FORCES ACTING IN AID OF CIVIL AUTHORITIES
Dispatch No. ___________________

It is certified that Mr./Ms son/daughter /wife of Shri/Smt. resident of (Name of village, Tehsil in case the deceased belongs to Rural Area and House number, name of Mohalla and area of town in which he/she belongs) was killed or became 100% physically disabled by the terrorists/security forces acting in aid of civil authorities on _________ in Village/Mohalla/Tehsil Town District. He was neither terrorist nor have any links with such elements. APPLICABLE TO GOVT. EMPLOYEES ONLY 1. He/She was working as ……………………….. in the Department ………………………….. at ……………………………………….. 2. This certificate is issued on the basis of the report of ……………………….. (Name of Police Authority) 3. The Certificate is issued on the request of Sh. ………………………………. (Name and relationship of applicant with deceased). of

Signature of the SDO (C) concerned with Seal CERTIFICATE OF DEATH/INCAPACITATION OF MILITARY/PARA/MILITARY PERSONNEL Certified that Mr./Miss/Mrs. is the son/daughter/spouse of Mr. percent incapacitated in terrorist action on Dated an applicant for admission to MBA/MCA course, who was killed or became hundered Signature of Authorized Office Official Seal CERTIFICATE FOR THE HANDICAPPED CANDIDATES
Dispatch No. Date:

Certified that from a loss of earning capacity of

son/daughter of Shri

suffers

a) 50% or more b) 40% or more but less than 50% as per the criteria laid down by the Punjab Government.

Dated:_____________

Chief Medical Officer