Category-I Certificate: SC/ST/*Non creamy layer OBC

*Non creamy layer SBC

CERTIFICATE
CERTIFICATE REGARDING SCHEDULED CASTE/SCHEDULED TRIBE/*NON CREAMY LAYER
OTHER BACKWARD CLASSES/*NON CREAMY LAYER SPECIAL BACKWARD CLASSES
(This certificate must be signed by District Magistrate/Executive Magistrate/
Additional District Magistrate/Sub Divisional Magistrate/Tehsildar of the District/
Place of which the candidate is a resident.)

I,……………………… ...................……………….. certify that Shri/Kumari .....………….…………………… is

(Name of the District Magistrate/Executive Magistrate /S.D.M. / Tehsildar)

the natural born (not adopted) son/daughter of Shri ……………….…...……………………..................

and belongs to Scheduled Caste/Scheduled Tribe/ Non Creamy Layer Other Backward
Classes / Non Creamy Layer Special Backward Classes …..…………..............
(Name of the caste)

by birth as notified under Presidential Order for the State of Rajasthan in ..............….…………
District ……….............……..………….
(Village/Tehsil)

Signature of the District Magistrate/

Date: Court Seal Executive Magistrate
Addl. District Magistrate /S.D.M./Tehsildar

OR
If the above certificate, issued by competent authority, is already available then attach the attested
photocopy of that certificate.

* (a) For non creamy layer OBC/ non creamy layer SBC candidates, the above certificate should be
issued by the competent authority and should not be older than one year. (b) Non creamy layer
OBC/ non creamy layer SBC candidates will have to furnish an undertaking in the following format
along with the above certificate.
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UNDERTAKING BY NON CREAMY LAYER OBC/ NON CREAMY LAYER SBC CANDIDATES

I,………………...…… ...................………….. son / daughter of Shri ..............………….……………………

resident of village / town / city .......................... district ................................. Rajasthan
State hereby undertakes that I belong to the community which is recognised as a backward
class by Government of Rajasthan for the purpose of reservation for admission in the state
of Rajasthan. It is also declared that I do not belong to persons / sections covered
within the meaning of "Creamy Layer" as defined in the notifications issued by the
Department of Personnel, Government of Rajasthan.

I declare that status / income of my parents / guardian is below the prescribed limits for
creamy layer as on financial year ending on March 31, 2011.

That in the event of declaration being found false misleading or incorrect during or after
Pharmacy programme, I will not have any objection whatsoever against the action taken in
the matter, which I understand, shall not be less than termination of the program and if the
degree of programme has been awarded, the same shall be cancelled forthwith.

Place: Signature of the Candidate

Date: Name of the candidate

Category-II Certificate: EXS1/EXS2

CERTIFICATE
CERTIFICATE FOR CHILDREN OF DEFENCE PERSONNEL KILLED OR SEVERELY DISABLED
(TO BE SUBMITTED BY THE CHILDREN OF DEFENCE PERSONNEL * PARA-MILITARY FORCES** KILLED
OR
SEVERELY DISABLED*** IN ACTION DURING HOSTILITIES/WARS OR ON DUTY DURING PEACE TIME)

(This certificate must be signed by the Commandant or OIC Records to which the
Soldier/JCO belongs. In case of officers of Army, Navy & Air-Force, this certificate must be
signed by the Service HQ of respective branch)

I, ….......................…………………………………..…………………..…………...............………..…………………..
(Service No., Rank of certifying officer)

certify that ….…….................…….….….….….….….….….….….….….….….…..................….….….….….

(Service No., Rank and Name of defence personnel- disabled or deceased)

Natural Father of …………………....................………………………………………...…….............……………….

(Name of applicant)

EXS1 was killed in action

or
EXS2 Disabled in action and boarded out from service/Died while in service with
death attributable to military service/Disabled in service and boarded out with
disability attributable to military service

….………………………………………………………………………………..……………………
(Mention severe disability and its percentage as per medical board)

His particulars are:

1. Service No., Rank & Name of the person ......................……..……..……..…………….………………
2. Name of the Unit last served ……..……..……..……..……..………………………..…..……………..
3. Date of enrolment ....…..……………… Date of death/discharge/retirement …....……..……..…....
4. Home town in Rajasthan as given by him at the time of his entry into service is ……….......
.…………...…………...…………...…………...…………...…………...…………………........................................
5. His Registration/Identity Card No. is ....................…………...………….. dated …………...……….
and P.P.O. No. is …………...………….......

Signature …….……….……….……
Date: Seal of Office Name .……….……….……….……

* Defence personnel will mean Commissioned Officers, Junior Commissioned Officers, other ranks,
noncombatant (enrolled) and their equivalent ranks in Navy and Air-Force of Rajasthan origin
only.
** Para Military forces consist of Border Security Force, Central Reserve Police, Assam Rifles and
Indo-Tibetan Border Police. Applicable to personnel of Rajasthan origin only.
*** As per GOI Ministry of Home Affairs, Department of Personnel and Administrative Reforms,
Order No. 14024/6/77 Estt.(D), dated 31-12-1979, severely disabled means with over 50
percent disability and unfit for employment but disability attributable to military service.
OR
If the above certificate, issued by competent authority, is already available then attach the
attested photocopy of that certificate.
Category-II Certificate: EXS3

CERTIFICATE
CERTIFICATE TO BE SUBMITTED BY CHILDREN OF GALLANTRY AWARD WINNERS

Please attach attested photo copy of Gallantry award certificate issued by competent
authority along with the certificate having particulars about the serviceman.
Category-II Certificate: EXS4

CERTIFICATE
CERTIFICATE TO BE SUBMITTED BY CHILDREN OF EX-SERVICEMEN*

I, …………………………………………….....................……………………………………………………………
(Service No., Rank & Name of the Certifying Officer)

certify that ……..……..…..……..……..……..……..…….......................……..……..……..……..……..………...

(Service No., Rank & Name of the Ex-Serviceman)

Natural father/mother of …………………..………………………….....................……………….... is / was

(Name of Applicant)

Ex-serviceman. His/Her particulars are:

1. Service No., Rank and Name of the Person …………….........................……………………………….….
2. Name of the Unit last served ……….…………………………...................................................................
3. Date of enrolment ……..…………..….......................... Date of retirement …………...……………………
4. He/She is/was ex-serviceman of Rajasthan origin and his/her home town as given by him/her at the
time of his/her entry into service is …..........................................……………………………………………
5. His/Her Registration/Identity Card No. is ……………..…………................... dated ….....................…...
and PPO No. is . ………………………………..

Signature ...................................
Name …......................................
(District Soldier Welfare Officer)
Date Seal of Office Name of District ..…..…..............

*(1) Definition of Ex-servicemen shall be as per Hand Book on Resettlement of Ex-servicemen (1995).
(2) Ex-servicemen should be of Rajasthan origin. The State of origin and the home town as entered
in discharge certificate shall only be accepted as proof in respect of above.
OR
If the above certificate, issued by competent authority, is already available then attach the attested
photocopy of that certificate
Category-II Certificate: PH

CERTIFICATE
CERTIFICATE REGARDING PHYSICALLY HANDICAPPED CANDIDATE

(To be given by authorized Medical Orthopedic Surgeon of the rank of Professor/ Associate Professor/Head
of the Department of a Government Medical College/Hospital or by District Medical Board)

This is to certify that Shri / Kumari …….........................……………..……………………………………………

Son/Daughter of Shri …………………….…..……………........................………………………………....... is a

Physically Handicapped (Disabled) candidate in terms of the accepted norms. The percentage of

handicap is …...…………… The nature of handicap/ disability is as follows:

………………………………….……………………………………………………………………………………......

(Signature of the Candidate)

Place: Signature of Orthopedic Surgeon / Medical Board
Date: (with Official Seal)

OR
If the above certificate, issued by competent authority, is already available then attach the attested photocopy of that
certificate