SELF DECLARATION (UNDERTAKING)

Application Number:
Candidate's Name: Father/ Husband's Name:
Gender: Date of Birth:

Candidate's Signature

I, _____________, resident of______________________________________________________________________, do

hereby, declare the following:

1. That, I have read the Instructions, Guidelines, and relevant orders about COVID-19 pandemic. I have read Information
Bulletin, Instructions, and Notices related to the personal interview available with the Invitation Letter.

2. I have in the last 14 days (please tick, wherever it applies to you, otherwise leave blank):
the following flu-like symptoms:

Fever: Cough: Breathlessness: Sore Throat/ Running Nose Body ache:

Others- Please specify:

_____________________________________

a) been in close contact with a confirmed case of the COVID-19. ('Close contact' means being at less than one meter for
more than 15 minutes)

b) not been in close contact with a person suffering from COVID-19 and am NOT under mandatory quarantine
c) traveled the following cities/ country in the last 14 days before arriving at the Centre

1st City 2nd City 3rd City 4th City

Name of cities/country

Date of Arrival in Centre

City
3. The health and wellbeing of our community is our priority; therefore, the interview management team reserves the right to
deny entry to its premises.
4. I/ we have read the detailed “ADVISORY for CANDIDATES REGARDING COVID-19” as given on Page-2 and I/ we
undertake to abide by the same.

Candidate Signature

The above undertaking has to be filled up in advance before reaching the venue, except the candidate signature which has to
be done in the presence of the SAMS team.

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 ADVISORY FOR CANDIDATES REGARDING COVID-19

SAMS will implement Social Distancing measures as per the Government of India/ Uttar Pradesh guidelines in the current
scenario of COVID-19 to ensure the health &safety of the candidates. Adequate measures are implemented for the safety
of all without compromising the high standards, sanctity, and fairness in the conduct of the examination. Candidates are
also required to adhere to guidelines and the new process for Social Distancing and hygiene to ensure the safety & health
of their own and fellow candidates.
For safety purposes, SAMS strongly advises candidates not to bring anything other than permitted items.

Preparation at Venue
1. Standard Operating Procedures for implementing safety precautions and for maintaining the required standard of
hygiene are getting implemented.
2. Candidate must wear a fresh mask at all the time of the process.
3. Hand Sanitizer will be available at entry and other places for candidates and venue staff to use.
4. Candidate to reach the venue as per the Reporting time at the given address in the invitation letter to avoid any crowding
at the venue to maintain social distancing.
Pre-Interview Preparation
1. Candidate to check Reporting time at Venue given in the invitation letter and to reach the venue as per Reporting time
only to avoid any crowding at the venue to maintain social distancing.
2. Candidate should fill the Self Declaration (Undertaking) as per instructions completely and properly.
3. Candidates will be permitted to carry only certain items with them into the venue:
• Personal Interviews related documents (Invitation Letter, ID card, etc. Please refer to Invitation letter for more
details)
•A simple transparent Ball Point Pen
•Personal hand sanitizer (50 ml)
•Personal transparent water bottle

At Venue
1. Candidates will be required to sanitize hands with Hand Sanitizer before venue entry. Hand sanitizer will be available at
various locations at the venue.
2. Candidate should bring duly filled in Self Declaration (Undertaking) as per instructions.
3. The filled-in Self Declaration (Undertaking), and body temperature (using Thermo Guns) will be checked and venue
staff will guide you to respective place, Candidates are required to strictly adhere to instructions provided by venue
staff.
4. Candidate must submit the Self Declaration (Undertaking) to the SAMS team.

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