Professional Documents
Culture Documents
SELF - DECLARATION
I hereby declare that I don’t have any of the below listed symptoms.
Cough Fever
Cold/Runny
Breathing Problem
Nose
I’m cer�fying that I’ve NOT been iden�fied as a poten�al carrier of the COVID-19 virus. I also unde
health and well being of our community is our first priority; therefore the exam centre reserves th
entry to its premises.
Candidate
.........................................................................................................................................
Name:
Roll No.: .........................................................................................................................................
Date of
...............................................11.01.2023 Wednesday....................................................
Exam:
Exam
Centre
.........................................................................................................................................
Name &
Address:
.........................................................................................................................................
Signature
of .........................................................................................................................................
candidate:
The Candidate must fill up the above self declara�on and keep the same with him/her. He/She mu
declara�on at the �me of entry in the examina�on centre, if asked for.
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Application
Centre No. : 18102 Roll No.
Number
22101467907 220218102050121
Examination Centre Details :
CLOUD9 CYBERSPACE Date of Birth Gender
2ND FLOOR, CKR JUNCTION TPIN : 19920613
13-06-1992 Male
BUILDING, NH66,
PALLIKUNNU, Category Is Differently Abled Photograph
KANNUR,KERALA, CKR Yes - Locomotor
JUNCTION BUILDING SC
Impaired (Ortho)
Language
Language Offered 2
Offered 1
Kannada English
Subject
Candidate's Address : Offered for Social Science
S/O BAILAPPA MADAR Paper II
BHAIRAMATTI Date of
BHAIRAMATTI BAGALKOT Paper Timings
Exam
KARNATAKA 587115
02.30 PM
11.01.2023
II TO 05.00
Wednesday
PM
Reporting Time 01:00 PM
Candidate's Name : Gate Closure Time 02:15 PM Candidate's Signature
HANAMANT MADAR
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CANDIDATE MUST CARRY: 1. DOWNLOADED ADMIT CARD 2. ONE PHOTO ID PROOF(PAN CARD,AADHAR
CARD, PASSPORT, DRIVING LICENCE, VOTER ID CARD) 3. BALL POINT PEN (BLUE/BLACK) OF GOOD QUALITY 4.
SANITIZER TRANSPARENT BOTTLE (50 ML) 5. MASK 6. WATER BOTTLE TRANSPARENT (500 ML)
Only permi�ed items are allowed in the Examina�on center. The Centre will NOT be responsible for the safe
custody of barred items.
LIST OF BARRED ITEMS WHICH ARE NOT ALLOWED IN THE EXAMINATION CENTRE IN ANY CIRCUMSTANCES
BOOKS, NOTES, BITS OF PAPERS, GEOMETRY/PENCIL BOX, PLASTIC POUCH, PENCIL POUCH, PENCIL, SCALE,
LOG TABLE,WRITING PAD, ERASER, CARDBOARD, ELECTRONICS DEVICES, WATCH, WRIST WATCH, WALLET,
GOGGLES, HANDBAG, MOBILE PHONES, EARPHONE, MICROPHONES, CAMERAS, HEADPHONES, PEN-DRIVES,
PAGER, BLUETOOTH DEVICE, CALCULATOR, DEBIT/CREDIT CARD, ELECTRONIC PEN/SCANNERS, FOOD and
BEVERAGE (ALCOHOLIC OR NON-ALCOHLIC) AND OTHERS ITEMS WHICH COULD BE USED FOR UNFAIR MEANS.
INSTRUCTIONS FOR OTHER CATEGORY OF PERSONS WITH BENCH MARK DISABILITIES:
1.The provision of scribe can be allowed only on produc�on of a cer�ficate to the effect that the person
concerned has physical limita�on to write and scribe is essen�al to write examina�on on his/her behalf,
from the Chief Medical Officer/Civil Surgeon/Medical Superintendent of a Government Health Care
Ins�tu�on as per Proforma at Appendix of Office Memorandum dated 29.08.2018 issued by Ministry of
Social Jus�ce & Empowerment and available on CTET website h�ps://ctet.nic.in
2.The candidate must bring his/her own scribe, the qualifica�on of the scribe should be one step below the
qualifica�on of the candidate taking the examina�on. The candidates with benchmark disabili�es should
submit details of the scribe as per proforma at Appendix-II of Office Memorandum dated 29.08.2018 as
stated above.
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