To

DGM (HR)
The Fertilisers And Chemicals Travancore Limited
Udyogamandal

Sub: Self Declaration by candidate – Reg:

Ref: Recruitment Notification No. 2/2024 dated 12.02.2024

Sir/Madam,

1. I declare that I am not convicted in any criminal case nor I am involved in any criminal case and there
is no criminal case pending against me in any of the courts / police stations.

2. I further declare that my following educational qualification which is being considered for the post of

in Recruitment
Notification No.2/2024 dated 12.02.2024 was acquired as a full time regular course at the College /
Institute mentioned below and the qualification/course is approved / recognized by UGC / AICTE /
AIU (Association of Indian Universities)ICAR (Strikeout which is not applicable) and is not acquired through
part time / correspondence / distance / private study / off campus

Full time regular

S.No. Education Qualification College University / AICTE
course – Yes / No

I understand that at any stage, it is revealed that the declarations as above is or are false, I will be
disqualified and will not be considered for selection/service will be terminated forthwith without
assigning any further reasons.

Signature
Name
Application No / Roll No:
Date