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‘wreris PTI /ATTESTATION FORM
aferersies renter a | 4 “arate”
( Sehiiex x o Tehiey a wetet Tare wel wedi fecar frat
a werren wraifet
wie wh ot df
virerdi.
Affix signed Passport size
(5 cmsx Jems)
Approx copy of recent
photograph
ornid agentes aed ceq1 sacar
caret art oefawara Ages, onfr Proce eT
TITTY HATS HAH SUT STF.
The furnishing of false information or suppression of any
factual information in the Attestation Form would be
disqualification and is likely to render the candidate unfit
for employment under the Government.
BT Ph We Wee Seariae, GR SAINTS
WIRE $d.seH SWI ses, Bees Aesferara
Fag Gohl VAT g. HS WE al Tuell Va res
aT afespsa wroftwars anes Var car sfeeT-aATT
THs Halen Wea, aI SWAT HE Hea
aqgerifiasta ated ceq7 sacar wowed
age.
If detained , arrested prosecuted, bound down, fines
convicted, debarred, acquitted etc. subsequent to the
completion and submission of this form, the details should
be communicated, immediately, to the the authorities to
whom the Attestation Form has been sent early. failing
which it will be deemed to be a suppression of factual
information
orraet aah Gare aa wed TPIT
ad mfedt wee woh fbar aaien afedt eeq7
sacar Pashia oe ae At ara fore Bar wares
BRIN WA BS.
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If the fact that false information has been fumished 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 services would be liable to be
terminated.
a Pr We Cae sera, ce wa] area aa
GRR) AE GR Gel Fra) Sumame Name
srard far oreararre’l werd Fees
wor seem far cadis ort
Tred sae PRN TS aaa)
Name in full fin block capitals} with
aliases, if any [Please indicate if you
have added or dropped in any stage, any
part of your name or surname]
2 | wearer apt Ger eeesra ara, aT a
fareet fibar ee ware eft sni/eeT
ante sree).
Present address in full [ie. Village, Thana
and District, or House
Number,Lane/Streel/ Road and Town],
7s ay ta 4