HARYANA STAFF SELECTION COMMISSION PANCHKULA

Bay No.67-70. Sector-2. Panchkula-134151

(www."h,s.sc.gov. in )

ln continuation of notice dated 18.t2.2019 for Scrutiny of Documents, it is notified for

information of the candidates for the posts Clerk, Cat. no. 01, against Advt. No. 05/2019 of
various Board/Corporations and Departments of Haryana state, Schedule of Scrutiny of
Documents is mentioned below.

DATE NAME OF ADVT. NO. PLACE ROLL NO.

THE POST 5t2019
CAT. NO.
01
07.01.2020 CLERK --DO-- TAU DEV! LAL 9990000006 to 9990107880 = 09:00 A.M.
STATD!UM 9990108148 to 9990196275 = 12:00 Noon
PANCHKULA, SEC,
03
08.01.2020 --DO-- --DO-- --DO-- 9990196350 to 9990283571 = 09:00 A.M.
9990283706 to 9990337757 = 12:00 Noon

09.01.2020 --DO-- --DO- --DO-- 9990337772 to 9990383129 = 09:00 A.M.

9990383375 to 9990428025 = 12:00 Noon

10.01.2020 --DO-- --DO-- --DO-- 9990428098 to 9990472754 = 09:00 A.M.

9990472938 to 9990515840 = 12:00 Noon

11.u.n;e(i --DO-- --DO-- --DO- 9990515866 to 9990566165 = 09:00 A.M.

9990566235 to 9990611782 = 12:00 Noon

13.01.2020 --DO-- --DO-- --DO-- 999061 1784to 9990660271 = 09:00 A.M.

9990560312 to 9990713215 = 12:00 Noon

14.01.2020 --DO-- --DO-- --DO-- 9990713353 to 9990768821 = 09:00 A.M.

9990769115 to 9990824594 = 12:00 Noon

15.01.2020 --DO-- --DO-- --DO-- 9990824621 to 9990883382 = 09:00 A.M.

9990883446 to 9990995113 = 12:00 Noon

16.01.2020 --DO-- --DO-- --DO-- 9990995150 to 9991158443 = 09:00 A.M.

9991158998 to 9991234386 = 12:00 Noon

17.01.2020 --DO-- --DO-- --DO-- 9991234425 to 9991272137 = 09:00 A.M.

9991272138 to 9991308360 = 12:00 Noon

18.01.2020 --DO-- --DO-- --DO-- 9991308530 to 9991342930 = 09:00 A.M.

9991342940 to 9991375589 = 12:00 Noon

19.0',t.2020 --DO-- --DO-- --DO-- 9991375608 to 9991411154 = 09:00 A.M.

9991411185 to 9991446846 = 12:00 Noon

20.01.2020 --DO-- --DO-- --DO-- 9991446892 to 9991485316 = 09:00 A.M.

9991485397 to 9991510321 = 12:00 Noon
lnstructions for filling online Sc(uliny form:

t, Click on "Fill Scrutiny form for the post of Clerk" on the website of HSSC ie. hssc.gov.in.
2. Fill the required fields as per original documents. lt is mandatory for the candidates to fill all
the fields and upload original documents which are applicable to candidates.

3. Take a printout after final submission of form. Before uploading the documents, candidate
shall number the documents and shall mention total number of pages and total number of
documents uploaded in the scrutiny form.
4. Bring the signed scrutiny form with all original documents and application form at the time

of document verification.

5. On the top of scrutiny from serial no, Time slot, committee allotted to candidates will be
mentioned and the candidates shall come accordingly.

Note:- Annexures for socio-economic criteria and others are attached herewith.

Dated Panchkula, Sd/-

The2O.L2.2Ol9 Under Secretary,
for Secretary Haryana Staff Selection Commission
Panchkula
 Annexu,re E:l
UNDERTAKING

I .................... Son/Daughter of .,,...,.........

District""""" ...', do hereby submit the following information for claiming marks
under the
socio-economic crileria namely;-

(1) That I am to apply for the post of ................ .in HSSC against

(?) That rny Aadhaar No.lpAN Card No./Voter tD No.(if any) is

13) That my father, mother, spouse, brother and son are /were not regular employee in
any
I)epartment/Boarcl/Corporation /Cornpany/Statutory Body
/Commission /Authority of Government of
ilaryana or any State Government or Government of lndia.

(4) That as no person as rrrentioned above had been in employment, I

may be allotted marks under
the seicio -econonric criteria.

{5} ihat I fully understand that the marks are given on the basis of infornration supplied by me and if
at an! ltaficr it is found that the information has been provided wrongly then not
only my service can be
lernrrnated on the ground of supply of wrong information even if without these marks
also my name
would have figured within the select list/recommendation list. lalso understand
that criminal action can
be taken against rne for providing wrong/false information.

l(j) That the deponent shall not take advantage of the certificate{s) issued by the Compdtent Authority
ii in the nteantime any other eligible person in my family obtains the benefits thereof in the
rFCfUitrtlf,nt

Piare;-
DIPONENT
Daie .

VERIFICATION:.
Verified that the contents of all the above paras are true to my knowledge
and belief
and nothing has been concealed therein.

Place:-
DEPONENT
Date:-
 No.
Date..
1,. This is to certify that Shri/Smt/Ms/Kumari

Of the Haryana State/Union Territory has

been serving as..

(complete nomenclature of the post)

in the office of

( De pa rtm enr / Bo ar d / Corpo n/com

ra t io pa ny/statuto ryBody/co m m iss io n/Au t ho rity of
Government of Haryana.

2. The Period of engagement was from.

to ................ ...,.........and the Complete years and months

are
(years & months).

3. The EPF account no. (if any) is/was

Place:
Date: Signature with seal of tssuing Authority (Head of
office)
Full Name
Designation
Address
Telephone No. with code
 Annexure-A-ll

GOVERNMENT QF HARYANA
ORPHAN CERTIFICATE

No

ccrtifreci thar the person wrth the detairs

mentioned berow is an orphan_.
i :\.iliru rl\ tJl.O(.K Ll:l"l.l:ltt

3. j ,Acldress
..,"
4 ;i Post Office
.

*-
s i it;i'.;ititlon -"

f'
,6.
,_---+---
----l
/ ' Caste
,j ---J
I'
B Father"'s Name I

e i ir,iu ;i;;i[e/s d;rh G*ffi;-d"ath

"-cg:i[qq!!)
1C , Morher's Namp

1"t ; Dair: of *olrei;s oejin i"nitor* aei*,

u Relationship with Guardian

1b Occupation ----l-
;^
lb - Aadhaar No (if
-
%=+_.,-
I

any)7pAN Card No. (if I

"" _. _. , ?ty)1y91_el "lp*I9.iLI alv)

Thrs ctrtificate is issued basecl on the details given in the

application, verification report, local enquiry,
{acts and records produced
by the applicant.

5ignature with seal of the Naib TehsildarlTehsildar

 Annexure-B-ll

GOVERNMENT OF HARYANA
WIDOW CERTIFICATE

No.

certified that the person with the detairs menrioned

berow is a widow:

1 \rrr; itN BLOCK if nlnl

*-*-l
\,'i i tlgt, --n
0 l',,st otlice; p* ft.|.
'il-r
7 \;rr:,c r,l ljltlrur-\l,,thrr.
I r Nanre of l{usband

9. Date of Death of Husband

10. AatJhaar ruo.iparv l;il- N;.^;l;
, !o,{f

This certificate is issued based on the details given rn

the applrcarron, Verificatron
Recorr, iocai enquiry, facts and records produced.

Signature with seal of the Naib Tehsildar/Tehsildar