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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