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Declaration by OBC Candidate

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×"ú ´Öï ______________________________ ÃÖ´Öã¤üÖµÖ ÃÖê ÃÖ´²Ö¨ü ÆæÑü •ÖÖê ³ÖÖ¸üŸÖ ÃÖ¸ü"úÖ¸ü «üÖ¸üÖ ÃÖê¾ÖÖ†Öë ´Öë †Ö¸ü*Ö!Ö
"êú ˆ§êü¿µÖ ÃÖê "úÖÙ´Ö"ú ‹¾ÖÓ ¯ÖÏ׿Ö*Ö!Ö ×¾Ö³ÖÖÖ "êú "úÖµÖÖÔ»ÖµÖ –ÖÖ¯Ö−Ö "Îú.: 36012 / 22 / 93-ãÖÖ. (
‹ÃÖÃÖß™üß ) פü−ÖÖÓ"ú 08.09.1993 ´Öë ×−Ö×ÆüŸÖ †Ö¤êü¿ÖÖë "êú †−ÖãÃÖÖ¸ü ׯ֔û›Íêü ¾ÖÖÔ "êú ºþ¯Ö ´Öë ´ÖÖ−µÖŸÖÖ ¯ÖÏÖ¯ŸÖ Æîü … “µÖÆü ³Öß
‘ÖÖêÂÖÖÖ úß •ÖÖŸÖß Æîü ×ú ´Öï ˆ¯Ö¸üÖŒê ŸÖ ÃÖÓ¤üÙ³ÖŸÖ ×¤ü−ÖÖÓú 08.09.1993 êú úÖµÖÖÔ»ÖµÖ –ÖÖ¯Ö−Ö úß †−ÖãÃÖæ“Öß êú úÖò»Ö´Ö
3 êú †ÓŸÖÖÔŸÖ ÃÖ´ÖÖ×ÆüŸÖ ¾µÖÛŒŸÖ / ¾ÖÖÔ ( ×Îú´Öß »ÖêµÖ¸ü ) ÃÖê ÃÖÓ²ÖÓ×¬ÖŸÖ −ÖÆüà ÆÑüæ ”…
I ______________________________________________________________ Son /
daughter of Shri ___________________________________________________ resident of
village / town / city ____________________________________________ hereby declare that
I belong to the community which is recognised 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 declared that I do not belong to persons / sections ( Creamy Layer
) mentioned in column 3 of the Schedule to the above referred Office Memorandum
dated 08.09.1993 ”.

ÆüßÖÖ*Ö¸ü / Signature : __________________________________

†³µÖ£Öá "úÖ −ÖÖ´Ö
Candidate’s Name : _____________________________________
ׯ֟ÖÖ "úÖ −ÖÖ´Ö
Father’s Name : __________________________________
†Ö¾ÖêפüŸÖ ¯Ö¤ü "úÖ −ÖÖ´Ö
Post for which applied: _____________________________________

†−Öã"Îú´ÖÖÓ"ú / Roll No. : _____________________________________________

¯ÖŸÖÖ / Address : __________________________________

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