FORM 4

DIRECTOR OF PUBLIC INSTRUCTIONS / EDUCATION OF THIS STATE OF

__________________

Certificate to meritorious sportsmen for employment to Group C & D Service under

the Central Government

Certified that Shri/Smt./Kumari _____________________________________________________

Son/Wife/Daughter of Shri _________________________________________________________
And resident of _________________________________________________________________

(Complete address) ____________________________represented the

______________________ country in the game/event
of ____________________________________________ competition / Tournament
held at _______________ from_________________ to _____________

The position obtained by the individual/team in the above-said Competition/Tournament

was______________________

The Certificate is being given on the basis of record available in the office of
Public Instructions/education of _____________________________

Place______________________ Signature _____________________________

Date ______________________ Name ________________________________

Designation ____________________________

Address _______________________________

Seal __________________________________

Note: This certificate will be valid only when signed personally by the Director or Additional/ Joint or Deputy
Director in overall charge of sports/games/ for schools in the directorate of Public instruction/ Education of the
State.