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gv CsyUU iv/Only for In-service candidates
CAzs J / ANNEXURE A
it v / CERTIFICATE
Cfzg J Cv izAqU ggz v AU Dv
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Verified that the applicant fulfills all eligibility criteria and facts have been tallied from his service
records. The check list below has been personally verified by the undersigned.
(J) CsyAi t g _________________________________________ v Pv

wg z ____________________________________________ v Pv
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(a) The Candidates Full Name ____________________________________. Present post of the
candidate _________________________________________ and working place of the candidate
______________________________________________.
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Ai 07.10.2014 P ____________________ Egvz.
(b) The Candidates Date of Birth, as per record is _________________. His age as on
07.10.2014 is _______________ .
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(c) The candidate is a Graduate as on 07.10.2014. He has passed __________________________
Examination from ______________ University in the year ___________ .
(r) CsyAi zR/it vP gV ______________________________

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(d) The candidate belongs to _______________ Caste/Group/Category as per Service
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(E) CsyAi ________________ gAz ESU jz. AP: 07.10.2014P

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(e) The candidate has joined the Police Department on ________________. His length of
Service as ASI/HC/PC as on 07.10.2014 is ________Years ______Months ______Days.
II
Pqv sz Cx Evg PgtUUV PPAq CAU jV.

For lack of records or otherwise. I am unable to verify the following.
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b. CgzsU vqVgz/ Involvement in Criminal Cases.
c. ew/zAi/U Caste/Group/Category
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35
gv CsyUU iv/Only for In-service candidates
CAzs / ANNEXURE B
Wu / DECLARATION
gv EPg () (g v ) / EPg (DgJL) (g) zAi Pw U CZAi CAzsU Ul Nz U
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I have read the provisions in the Notification regarding the Recruitment to the post of Inservice Police
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declare to abide by the sub-rules.
1) t g ______________________________________________ v Pv
wg z ______________________________ v Pv wg
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My Full Name ______________________________________ working as__________________ and
place of working ________________________________.
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Dzsjgvz. 07.10.2014 P Ai _____________________ Egvz.
My date of birth is ____________. My age as on 07.10.2014 is _____________. It is
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3) 07.10.2014P zzsgVz ________________ zAiAz ______________
z _______________ jPAi GwtVz. CzP DzsgV _____________
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I am a Graduate as on 07.10.2014. I have passed ________________ Examination from
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4)
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I belong to __________ Caste/Group/Category. The supporting document is __________ .
5) ___________________ gAz ESU jz. 07.10.2014P Ai

_____________ ________ wAU _________ UVgvz.
I joined the Police Department on ________________. My length of Service as on
07.10.2014 is _______________ years __________ months _________ days.
6)
Aiiz Q Pgtz VAiiVgAz U gz ES Zgu

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I declare that I have neither been involved in any Criminal case nor any Departmental
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z gU dAz F P Wv.
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I hereby declare that the above information is true. I am aware that I am liable for action against me in the
event of any information being found false or incorrect or ineligibility being detected before, during or after the
examination/interview/appointment.
Cz Ez UAi jPU dgUzAv vvi jPAz GZnnAz Wv.
I further declare that I have not been debarred from appearing for any similar examination.
Date/ AP:
Place/ :
CsyAi t
Signature of the candidate
36
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/ DAiPg, AUg Ug.
38
CAzs- J
DAiPgg Pb j, g Ug
i) EPg () (g) 10 S zU VPgt F PVAwz:
U
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
05
01
04
j ew
02
02
j AUq
01
01
U-1
01
01
U-2J
01
01
U-2
U-3J
U-3
Ml
10
01
09

F PVAwz:
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml

U
i U
j ew
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
Ml

CsyUAz vAUz.
/ DAiPg, g Ug.
39
CAzs- J
DAiPgg Pb j, -zgqs Ug
F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
02
02
j ew
01
01
j AUq
01
01
U-1
01
01
U-2J
U-2
U-3J
U-3
05
05
Ml
ii) EPg () () 01 S zAi VPgt F PVAwz:

Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml

Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
U
i U
j ew
Ml

CsyUAz vAUz.
/ DAiPg, -zgqs Ug.
40
CAzs- J
DAiPgg Pb j, AU
g Ug
F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
03
01
02
j ew
01
01
j AUq
01
01
U-1
01
01
U-2J
01
01
U-2
U-3J
U-3
07
01
06
Ml
ii) EPg () () 01 S zAi VPgt F PVAwz:

Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml

CsyUAz vAUz.
/ DAiPg, AUg Ug.
41
CAzs- J
DgPP jPP gg Pb j, Ai, AU
g
F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
04
01
03
j ew
01
01
j AUq
01
01
U-1
01
01
U-2J
01
01
U-2
U-3J
U-3
08
01
07
Ml

F PVAwz:
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml

U
i U
j ew
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
Ml

CsyUAz vAUz.
/DgPP jPPg, Ai,
AUg.
42
CAzs- J
DgPP G jPP gg Pb j, g, AU
g
i) EPg () (g) (Aivg) 08 S zU VPgt
F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
04
01
03
j ew
01
01
j AUq
01
01
U-1
01
01
U-2J
01
01
U-2
U-3J
U-3
08
01
Ml
07
ii) EPg () () (Aivg) 02 S zU VPgt

F PVAwz:
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
02
02
Ml
iii) EPg () Aig g (Aivg) 01 S zAi VPgt F PVAwz:

Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml

CsyUAz vAUz.
/DgPP G jPPg , g,
AUg.
43
CAzs- J
DgPP G jPP gg Pbj, g, AUg

zgz-PlP wUq AUg Ugz gd lz PbjAi Ai Azz
S zU
i) EPg () (g) (Ai) 01 S zAi VPgt F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml
zgz-PlP zPq S zU
i) EPg () (g) (Ai) 02 S zU VPgt
F PVAwz:
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
02
02
Ml
ii) EPg () () (Ai) 01S zAi VPgt

F PVAwz:
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml
/DgPP G jPPg, g, AUg.
44
CAzs
DAiPg PbjU v Ai PbjU S Eg -EPg
() (g & ) Ml zU VPgtz g
F PVAwz:
Ml
AidUAz
Ut
if
Pq
U
zU
gvUAq
Csy
Pg
izs
AS
Csy
i U
75
19
05
03
03
j ew
23
05
01
01
01
j AUq
09
01
-
Evgg
45
15
08
U-1
10
01
09
U-2J
21
05
01
01
01
13
U-2
05
01
04
U-3J
04
01
03
U-3
05
01
04
Ml
152
34
07
05
05
101
nt : Ut, if Pg, AidUAz gvUAq Csy v Pq izs CsyU
sz CAv S zU g Cz Uz Evg CsyUAz
vAUz.
ii) EPg 43 S zU VPgt
F PVAwz:
U
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
19
05
01
01
12
j ew
11
02
09
j AUq
03
03
U-1
02
02
U-2J
05
01
04
U-2
01
01
U-3J
01
01
U-3
01
01
Ml
43
08
01
01
33
nt : Ut, if Pg v Pq izs CsyU s z CAv S zU

g Cz Uz Evg Cs yUAz vAUz.
45
iii) EPg () Aig g 20 S zU VPgt

F PVAwz:
U
Ml
zU
AS
Ut
Csy
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
08
02
06
j ew
07
01
06
j AUq
01
01
U-1
01
01
U-2J
02
02
U-2
01
01
U-3J
U-3
20
03
17
Ml
nt : Ut v if Pg, CsyU sz CAv S zU

g Cz Uz Evg CsyUAz vAUz.
46
CAzs
zgz-PlP wUq AUg Ugz -EPg () (g &
) Ml zU g
F PVAwz:
U
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
05
01
04
j ew
03
03
j AUq
01
01
U-1
01
01
U-2J
01
01
U-2
U-3J
U-3
Ml
11
01
10
ii) EPg 03 S zU VPgt

F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
iii) EPg () Aig g 01 S zAi VPgt

F PVAwz:
Ml zU
AS
Ut
Csy
AidUAz
gvUAq Csy
Pq
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml
nt : Ut CsyU sz CAv S zU g Cz Uz
Evg CsyUAz vAUz.
47
zgz-PlP zPq Ai S zU g
i) EPg () (g) (Ai) 02 S zU VPgt
F PVAwz:
Ml
zU
AS
Ut
Csy
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
02
02
Ml
ii) EPg () () (Ai) 01S zAi VPgt

F PVAwz:
Ml
zU
AS
Ut
Csy
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
j ew
Ml
/qn EPg dg Ds ,
Pw v vgw U z PAiz,
EPg () Pw w,
Pl s, Cg g,
AUg-560 001.
48
CAzs- J
DAiPgg Pbj, AUg Ug
i) EPg (DgJL) (JDg/rJDg) (g) 15 S
zU VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
07
02
05
j ew
03
01
02
j AUq
01
01
U-1
01
01
U-2J
02
02
U-2
01
01
U-3J
U-3
15
03
12
Ml
ii) EPg (DgJL) (JDg/ rJDg) (g)

Aigg - 02 S zU VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
02
02
Ml
nt : Ut CsyU sz CAv S zU g Cz
Uz Evg CsyUAz vAUz.
/ DAiPg, AUg Ug.
49
CAzs- J
DAiPgg Pbj, AUg Ug
zgz-PlP wUq zAi g
EPg (DgJL) (JDg/rJDg) (g) 01 S
zAi VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
j ew
Ml
/ DAiPg,
AUg Ug.
50
CAzs- J
DAiPgg Pbj, g Ug
zU VPgt F PVAwz:
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
02
02
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
04
04
Ml
/ DAiPg,
g Ug.
51
CAzs- J
DAiPgg Pbj, -zgqs Ug
EPg (DgJL) (JDg/rJDg) (g) - 03 S
zU VPgt F PVAwz:
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
/ DAiPg,
-zgqs Ug.
52
CAzs- J
DAiPgg Pbj, AUg Ug
zU VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
/ DAiPg,
AUg Ug.
53
CAzs- J
DgPP jPP gg Pbj, Ai, AUg
i) EPg (DgJL) (JDg/rJDg) (g)
S zU VPgt F PVAwz:
- 04
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
02
02
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
04
04
Ml
ii) EPg (DgJL) (JDg/rJDg)

Aigg - 01 S zAi VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
j ew
Ml
(g)
/DgPP jPPg, Ai,

AUg.
54
CAzs- J
DgPP jPP gg Pbj, PAz Ai, AUg
zU VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
/DgPP jPPg,
PAz Ai, AUg.
55
CAzs- J
DgPP jPP gg Pbj, Ai, ztUg
zU VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
/DgPP jPPg,
Ai, ztUg.
56
CAzs- J
DgPP jPP gg Pbj, F Ai, UU
EPg (DgJL) (JDg/rJDg) (g) (Ai) 03
S zU VPgt F PVAwz:
U
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
/DgPP jPPg,
F Ai, UU.
57
CAzs- J
DgPP jPP gg Pbj, Gvg Ai, U
EPg (DgJL) (JDg/rJDg) (g)
zU VPgt F PVAwz:
05 S
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
02
02
j ew
01
01
j AUq
01
01
U-1
01
01
U-2J
U-2
U-3J
U-3
05
05
Ml
/DgPP jPPg,
Gvg Ai, U.
58
CAzs- J
DgPP jPP gg Pbj, zQt Ai, g
EPg (DgJL) (JDg/rJDg) (g)
zU VPgt F PVAwz:
05 S
Ml
zU
AS
Ut
Csy
if
Pg
AidUAz
gvUAq
Csy
Pq
izs
Evgg
i U
02
02
j ew
01
01
j AUq
01
01
U-1
01
01
U-2J
U-2
U-3J
U-3
05
05
Ml
.
/DgPP jPPg,
zQt Ai, g.
59
CAzs
DAiPg PbjU v Ai PbjU S Eg

EPg (g) (DgJL) (JDg/rJDg) Ml zU VPgtz g:
i) EPg (g) (DgJL) (JDg/rJDg) 45 S
zU VPgt F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvU
Aq Cs y
P q
izs
Evgg
i U
19
02
17
j ew
11
01
10
j AUq
09
09
U-1
03
03
U-2J
02
02
U-2
01
01
U-3J
U-3
45
03
42
Ml
nt : Ut CsyU sz CAv S zU g Cz
Uz Evg CsyUAz vAUz.
ii) EPg (g) (DgJL) (JDg/rJDg) Aigg S zU VPgt F PVAwz:

Ml zU
AS
Ut
Csy
AidUAz
gvU
Aq Cs y
P q
izs
Evgg
i U
01
01
j ew
02
02
j AUq
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
03
60
zgz-PlP zz -P wUq
EPg(g) (DgJL) (JDg/rJDg) Ml zU g
i) EPg(g) (Ai) 03 S zU VPgt
F
PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvU
Aq Cs y
P q
izs
Evgg
i U
01
01
j ew
01
01
j AUq
01
01
U-1
U-2J
U-2
U-3J
U-3
03
03
Ml
AUg Ugz -P wUq EPg(g)

(Ai) 01 S zAi VPgt F PVAwz:
Ml zU
AS
Ut
Csy
if
Pg
AidUAz
gvU
Aq Cs y
P q
izs
Evgg
01
01
j AUq
U-1
U-2J
U-2
U-3J
U-3
01
01
U
i U
j ew
Ml
/qn EPg dg Ds ,
Pw v vgw U z PAiz,
EPg (DgJL) (JDg/rJDg)
Pw w, Pl s, Cg g,
AUg-560 001.

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1

-EPg () v EPg (DgJL) (JDg/rJDg) zU Pw

ZU:J) -EPg () v -EPg (DgJL)

i U, U 2(J), 2(), 3(J), 3() U jz CsyUU

Cf gAs AP: 08.09.2014, U 10.00 UAmU

Cf PAi AP: 07.10.2014, Ae 06.00 UAmU

CPv AP Pbj Ai w PAi AP: 09.10.2014.

ESAi CPv m qVg CfAi Uv APzU

v iwU r Cf z CAvg gz PAi Pw wAi

D P CfAi swiq Azsz Jzgz Ait

zgz-PlP wUq AUg Ugz EPg

zgz-PlP zz -P wUq EPg

2) -EPg (DgJL) (JDg/rJDg) (g)

zgz-PlP zz -P wUq (Ai) zU g

zgz-PlP wUq AUg Ugz

3.4 DAiPg Pbj/Ai/WlPU PbjU AqAv S Eg

Az PgtAz qUqAiiz if AizsgVz CjU Cg z

3] EPg () v -EPg (DgJL)

P AiP (Lok Sahayak Sena) v g

CAv Az w Az Avg w v qAiwg

gu: QU PAz U Az w Az Avg if Pg

sgv Pgz CPv e v AS.36034/27/84-A (Jn), AP

P..J. (i Pw) Ai 9(1) gAi PAz Ai U

nt: if P w Pg Cs yU Aiig D wU Cg?

(DgJL) (JDg/rJDg) zUU Cf CsyUU:

ii] gv CsyUU zv v Cs : CAVPv zAiz z

ri Ev zvU zU i U. DzjAz EPg

8. v jP (Endurance Test) (En) v zzqsv jP (Physical

v v zzqsv jPAi AP, Ai v z iwAi MU

Js) v jP : (Endurance Test)

Gz: CsyAi JL () v DgJL(JDg/rJDg) zUU

Avg 7 vUzPAqg DU CsyAi JL() zU iv

J) -EPg () zUU Cf g CsyUU

UAq Jv (7.26 P.f.)

5.60 lgVAv Pr EzAv

) -EPg (DgJL) (JDg/rJDg) zUU

UAq Jv (7.26 P.f.)

gv v if P Cs yUU F PPAq v jPAi qUz

Z :v jPU dgU CsyU zPV zqsjgP. F jPU

F wPAi Azs g, gA g, sAvg U

CsyU wP-1 EAV Cx P qz Gvjz.

ii) CsyU Tv jPU Urg AiQAv Czs UAm AavV jP

) iTP jPU vgPz zRwU i) iTP jPAi Pgv ii) v v

w Pt At Pv z AgP. uAzsv, Ut Cx Aiiz Pt

ii) g jP (Webers Test)

jPU Aiiz vU PAq Az Cv JAz jUtUz.

Czs Hv Cv (Varicose Veins)

J jPU zQAi AqAi qvz. zj AqAi zPV

Ut wAi Pg Cs yAi 1 vgUwAz 10 vgUwAigU

CsyAi AU irz AU irz CAi CA PlP g

Ut wAi Pg Cs yAi PlP CZ AS.

CAvAi Ut w Pg j ew, j AUq, U-1, U2J, 2, 3J, 3 jz Cs yU -2g it v AAzsl

Z: Ut w Pg j ew, j AUq, U-1, U-2J, U-2,

14. Aid gvg:

16. zgz-PlP zPq CsyUU it vU :

J) d it v:- 1) dAz Ai QAi i

2) Cfzg vAz Cx v D zz 01-01-2013QAv AZ nz PgtAzV,

U/v/ltz z gAs v PAi APz g MUAv,

MAz U /v/ltP vUz Azsz, CAv

Pgt Dzz g 6(J) CrAi gAwzg, vgg rz z

PtP AAi Rg rz v D PtP AAi CPg Ag

Cfzg vAz-vAig Aiigzg

AU it v q GzPV, Pv PuPjAi, AAi Rg

r) it v:- 1) M Ai QAi Vg Ai, Ai

2) d AP DVgvz. Cz _ zRAi

__ ew/zAi/UP jz. CzP DzsgV _