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    Annex Ure

    Uploaded by

    Abhay Jha

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    © All Rights Reserved
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    Annex Ure

    Uploaded by

    Abhay Jha
    3 views4 pages

    Copyright

    © © All Rights Reserved

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    © All Rights Reserved
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    3 views4 pages

    Annex Ure

    Uploaded by

    Abhay Jha

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    You are on page 1of 4

    .Annexure-I.

    Application for Recruitment I Pay Band of Rs. 5200-20200-Grade Pay Rs. 1800 /-in South Eastern Railway
    Railway Recruitment Cell /South Eastern Railway, For Office Use Only
    BungalowNo.12A11, Garden Reach Road, Kolkata-43. Control Number ……………………………………
    Employment Notice No. SER/RRC/2/2010. Roll No.
    01. Category/Post applied for( indicate your order of priority /choice in the Box below
    Your will be considered for the post applied only

    Option/ Category Name of the Option/ Category Name of the Please paste
    (not older than
    Performance Number Post Performanc Number Post one month
    e recent Passport
    1. 3. size Photograph
    2. 4. 3.5x3.25cm
    with full Sign.

    02. Name of Candidate (In


    Block Capital Letters
    03. Father’s Name
    04. Date of Birth D D M M Y Y Y Y
    (DD/MM/YYYY)

    05. Community (Tick p) SC ST OBC UR

    06. Are you Physically Disabled : (Tick p) VH HH OH

    07. Address for Communication:

    PIN :

    08. Nationality:
    09. Religion:
    10. SEX(Tick p) M F
    11. Marital Status Tick p M UM DIVORCED

    12. Nearest Railway


    Station:
    13. Visible marks on Identification 1.
    (Moles etc. on your body) 2.
    14. Do you seek age relaxation under any of the category mentioned ? (Tick p appropriate Box)
    SC ST OBC Physically Course Completed Judicially separated/ Ex- Railway
    Disabled Act Apprentice divorced women/widow Serviceman Employee

    15. Educational Qualifications :-


    Qualification University/Board Year of Passing Subject % of Marks/Grade
    th
    SSC/10 . Class
    ITI
    Others

    16. List of Documents enclosed ( fill in the details of the Certificates/documents enclosed)
    i) iii) v)
    ii) iv) vi)
    Contd….2.
    (2)

    17. Details of IPO / Demand Draft enclosed with the application :-


    Name of the Post Office /Bank Serial No. & Date Amount

    18. Choice for Language for written


    Examination

    19. Declaration by the Candidate : ( Copy the passage in the box below in your running hand writing ):-
    I declare that all the particulars given above by me are true , complete and correct to the best of my
    Knowledge and belief . I am aware that in the event of any information furnished by me is found /
    Incorrect at any stage, my candidature will be rejected summarily and I am also liable for criminal
    Action . I will abide by the instruction given in the notification.

    Place:

    Date: Left Thumb Impression Signature of the Applicant

    Annexure-5
    LIST OF MINORITIES AND PROFORMA FOR INCOME CERTIFICATE
    FOR ECONOMICAL BACKWARD CLASSES
    1. Minorities will mean Muslims, Christians, Sikhs, Buddhists and Zoroastrians ( Parsi).
    2. Economically Backward classes will mean the Candidates whose family income is less than Rs.50,000/- Per
    Annum. the following authorities are authorized to issue income certificates for the purpose of identifying
    economically backward classes.
    i) District Magistrate or any other Revenue Officer up to the level of Tehsildar.
    ii) Sitting Member of Parliament of Lok Sabha for persons of their own constituency.
    iii) BPL Card or any other certificate issued by Central Government under a recognized poverty alleviation
    programmed or izzat MST issued by Railway.
    iv) Union Minister may also recommended to Chairman/ RRB’s for any persons from any where in the country.
    v) Sitting Member of Parliament of Rajya Sabha for persons of the district in which these MP’s normally reside.

    FORMAT OF INCOME CERTIFICATE TO BE ISSUED ON LETTER HEAD AS PER PARA-3 OF LETTER


    NO.: E(RRB)/2009/25/21 DATED: 28.10.2009 INCOME CERTIFICATE FOR WAIVER OFF EXAM. FEES
    FOR RRB EXAMINATION

    1. Name of Candidate :
    2. Father’s /Husband’s Name :
    3. Age :
    4. Residential Address :
    5. Annual Family Income :
    (in Words & Figures)
    6. Date of Issue :
    7. Signature :

    8. Stamp of issuing authority with full name,


    Designation, location etc. (Name)
    Contd….3.
    (3)
    Annexure-3
    SELF DECLARATION OF MINORITY CANDIDATES FOR WAIVER OF EXAMINATION
    (Performa for declaration to be submitted by Minority candidates along with the application for
    the post against Employment Notice No. ………………….……………………………………….)

    DECLARATION

    I, _____________________________________ son/daughter of Sri _______________________________


    resident of village/town/city _______________________ District ___________________ State ________________
    hereby declare that I belong to the ___________________________( Indicate minority community notified by Central
    Government i.e. Muslim/Sikh/Christian/Buddhist/Parsis).

    Place: Signature of the Candidate

    Date: Name of the Candidate

    Note:- At the time of document verification such candidate claiming waiver of examination fee will be required to
    furnish ‘minority’ community declaration affidavit on non-judicial stamp paper that he/she belongs to any of the
    minority community notified by Central Government (i.e. Muslim/Sikh/ Christian/Buddhist /Parsis)
    ----------------------------------------------------------------------------------------------------------------------------------------

    Annexure-4
    Performa for declaration to be submitted by Other Backward Class Candidates along with the application
    while applying for the posts against Employment Notice No ___________________________________________
    of RRC________________________________

    DECLARATION

    I, _____________________________________ son/daughter of Sri _______________________________


    resident of village/town/city _______________________ District ___________________ State ________________
    hereby declare that I belong to the ___________________________( Indicate your Sub-Caste) community which is
    recognized as a backward class by the Government of India for the purpose of reservation in services as per orders
    contained in Department of Personnel and Training Office Memorandum No. 36012/22/93- Estt(SCT)
    dated:08.09.1993. It is also declare that I do not belong to persons/sections ( Creamy Layer) mentioned in column 3 of
    the Schedule to be above referred Office Memorandum Dated: 08.09.1993 and its subsequent through O.M.
    No.36033/3/2004-Estt.(Res) dated:09.03.2004”

    Place: Signature of the Candidate

    Date: Name of the Candidate

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