HIMACHAL PRADESH PUBLIC SERVICE COMMISION

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 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 Qualification---from Matriculation onwards:
Sr. Exam. % age of Year of
Board/University Subjects
No. Passed Marks Passing
1

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

Relation Name Nationality Place of Occupation Address

Birth
Father
Mother
Wife/
Husband
Brother(s)
Sister (s)
9. 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).

10. Give Chronological detail of your employment:

Whether
Remarks/reasons
Sr. Name of Post Permanent/
From To for leaving previous
No. Deptt./Company held Temporary/
service
Tenure
1

11. Particulars of places including foreign (with period of residences) where

you have resided for more than one year at a time during the preceding five
years:
Name of the District Head
quarters of the place
From To Residential address in full
mentioned in the preceding
column.

12. Nationality ……..………………………….

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

(b) Present age ……………………………………

14. Hobbies:
15 Noteable achievements

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

17. (a) Do you belong to any prescribed reserved

category of Himachal Pradesh?

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

18. (a) Have you ever been arrested ? Yes/No

(b) Have you ever been Prosecuted ? Yes/No
(c)Have you ever been Kept under detention? Yes/No
(d) Have you ever been bound down? Yes/No
(e) 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? Yes/No
If “YES” give details.
 19. Have you ever been disqualified, debarred from appearing in any examination?
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 Officers 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.

 Annexure

CHARACTER CERTIFICATE
(To be issued by Executive Magistrate/ Tehsildar/ Naib Tehsildar or any other Gazetted Officer)

Certified that Mr/Ms. ……………………………………..................………….... son/daughter/wife of

Shri …………………………………………………… resident of …………………………… ………………..
……………… ………………………… ………………………. …………………….. ……………………… ………… is well
known to me since last …..…….. years and ………….…… months. To the best of my
knowledge and belief he/she bears a good moral character and has nothing which debars
his/her suitability for Government Job. Mr/Ms. ................................................. is not
related to me.

Place: ………………… Signature …………….……….

Dated: ……………….. Designation ………...…………

Office Seal