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14-10-2015 APPENDIX (A,B & C)

Appendix A

 

SELF CERTIFICATION CERTIFICATE (ONE FOR EACH TATTOO) BY

CANDIDATES FROM TRIBAL COMMUNITIES WITH PERMANENT

BODY TATTOO(S)

 

I,    ______________________    (Name    of    Candidate),    Son/    Daughter    of
_____________________    (Name    of    Father/Mother/Guardian    as    applicable)
____________    (Date    of    Birth)    hereby    give    an    undertaking    that    I    belong    to
__________________ Tribe from ____________ area of _____________ State and I do not have any permanent body tattoo on my body/I have one/two/three/ four/more than four * permanent body tattoo(s) inked on my body as follows (one for each tattoo):-


Photograph of Tattoo:-  (Post card size to be pasted here duly signed by the

candidate with name. Please do not use staple pins/clips).


Details of Tattoo :- Size of Tattoo -(In Cms)

Language    - (If Applicable)    

Significance of Tattoo - (If Applicable)   

(* Delete whichever is not applicable)       

2. I am enclosing Certificate(s) as per Appendix B, in original, for permanent body tattoo(s) on my body, duly signed as per instructions.

3. I hereby declare that besides the tattoo(s) as referred in Para 1 of Appendix A above, I will not have any other permanent body tattoo(s) in future if I am selected to undergo pre-commission training.

4.    The above information given by me is true and correct to the best of my knowledge and belief.

5.    I understand that misrepresentation of any facts/concealment of any information regarding permanent body tattoo(s) will lead to cancellation of my candidature at any stage from commencement of the selection process and I shall be solely responsible for the same.

Place:
_______________________

Date :    (Signature of the Candidate)
Name, Entry & SSB Batch No


Appendix B

CERTIFICATE (ONE CERTIFICATE FOR EACH TATTOO) FOR PERMANENT BODY TATTOO IN RESPECT OF CANDIDATES FROM TRIBAL COMMUNITIES


1.    This is to certify that ________________ (Name of Candidate) whose date of birth is ____________ is the Son/ Daughter of _______________ (Name of Father/ Mother/ Guardian as applicable) and belongs to __________________ (Name of the Tribe) Community of _______________ (Name of the District) in the State of

________________ (Name of the State).

2.    It is certified that the permanent body tattoo(s) inked at the following parts of the body of __________________(Name of the candidate) is as per existing customs and traditions of ____________ Tribe and is in practice as on date :-

(a)

(b)

(c)

(d)
(Total No of Tattoos both in figures and words)

3. Post card size photograph of each of the tattoo as given in Paragraph 2 of Appendix B above is correct and placed as under for any future reference / record hereafter:-

Photograph of Tattoo :- (Post card size to be pasted here duly signed by the candidate and official issuing this certificate with their respective names. Please do not use staple pins/clips).

Details of Tattoo

Size of Tattoo    -(In Cms)   
Language - (If Applicable)   
Significance of Tattoo -(If Applicable) 

Note- Each tattoo will have a separate photograph with details and will be described separately. Additional pages will be used for the purpose and each page will be attested separately.


Place : Affix Round Stamp (Signature with Name, Designation and Stamp of DC/DM or SDM of the District/Tehsil)

Date :
Affix Round Stamp :OR (Signature with Name, Designation if any and Address of Chairman/Secretary or Senior Member of the Tribe to which the candidate belongs to with their Stamp). 

Appendix C

This certificate will be provided to a candidate appearing for the SSB Interview by the concerned Selection Centre.


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