Gllej ØeosMe YetlelJe SJeb Keefvekeâce& Advertisement. No.

UTTAR PRADESH PUBLIC SERVICE COMMISSION

efveosMeeueÙe DeOeervemLe ØeeefJeefOekeâ mesJee D-1/E-1/2023
Date: 02-02-2023

LAST DATE FOR THE PAYMENT OF ONLINE APPLICATION FEE IN THE BANK : 02.03.2023
LAST DATE FOR SUBMISSION OF ONLINE APPLICATIONS : 06.03.2023
IMPORTANT - (1) "Incomplete Online Application- candidates are required to enter all the required Social Uplift Officer, Group-'B', Nature of Post:-Gazetted,
Form shall be rejected and no communication in this informations in the format. The photo and signature duly Reservation:- According to the existing Govt. Orders,
regard shall be entertained." scanned shall be uploaded also. The candidate should Department No.- S-4/1, Pay Scale:- Level-7, Pay-Matrics-
(2) "If at any stage, it comes to the knowledge of the scan his/her photograph and signature in the prescribed 44,900-142400 (Pay Band-9300-34800, Grade Pay-4600),
commission that the candidate has concealed or size (the size will be mentioned at the specified spot in the Academic Qualification:- (A) Essential Qualification- A
misrepresented any information, his candidature shall On-line application). This should also be kept in notice that candidate must possess a Bachelors degree with
be rejected and proceeding to debar him from future the photo must be latest passport size. In case the photo Economics and Sociology of a recognised University and
examinations and selections shall be initiated." and signature, scanned in the prescribed size, are not must also possess a good knowledge of Hindi in Devnagri
uploaded, then the On-line system will not accept it. The script : Provided that preference will be given to candidates
(3) "The candidates are directed to ensure at the time of
procedure related for scanning of the photo and signature who possess one or more of the following qualification : (i)
online application the preservation of information is laid down in the Appendix-1. After filling in all entries in Master's or Higher Degree in Economics or Sociology or
regarding all the stages (i.e. Registration, Fee payment, the format, the candidates may click “PREVIEW” to see Social Welfare ; (ii) A recognised Degree or Diploma in
Final submission etc.) in Soft/Hard copy for future for themselves that all entries and informations are Social Service, Applied Sociology, Social Science, Social
references." correctly entered and after satisfying themselves should Technique, Social Work or Social Service Administration;
SPECIAL NOTICE :- (a) "Applications will be accepted only click "Submit" button to forward the same to the (iii) A degree in Law; (iv) Practical experience of prohibition
when fee is deposited in the Bank upto prescribed last date Commission. It is essential that the candidate should fill all and Social Uplift. (B) Preferential Qualification: A
for fee payment. If the fee is deposited in bank after the last informations On-line correctly according to the instructions candidate who has: (1) served in the territorial army for a
date prescribed for fee payment, the on-line application of given and click the 'Submit' button by the last date minimum period of two years, or (2) obtained a "B"
the candidate will not be accepted and the fee deposited in prescribed for submission of the application form. If the certificate of National Cadet Corps, shall, other things
candidate does not click the "Submit" button, the On- Line being equal, be given preference in the matter of direct
the bank will not be refunded in any condition. It will be
application process shall not be completed finally and the recruitment. Note- Candidates will have to annex self
responsibility of the candidates to pay fee in the bank upto candidate shall be accountable for this. After clicking the attested copies of all session's mark sheets essentially
last date prescribed for fee payment and 'submit' the 'Submit' button, the candidate may take a print of the along with self attested copies of all other required
application upto last date prescribed for submission of application to preserve it with them. In the event of any certificates, at the time of demand of records. Age Limit:-
applications. It is also informed that less or more amount discrepancies, the candidate will be required to submit the 21 to 40 years.
deposited in the form of application /examination fee shall said print in the office of the Commission, otherwise his/her Department of Excise, U.P.
not be refunded in any condition." (b) In Online Application request shall not be entertained. 02 Posts (Unreserved) of Technical Officer, U.P. Excise
System, the candidates have to provide their registered 2. Application Fee : In the ON-LINE Application process Technical Service, Group-B, Nature of Post:- Gazetted,
Mobile No. and e-mail ID in prescribed column failing which after completing the procedure of first stage, category wise Reservation:- According to the existing Govt. Orders,
their Basic Registration shall not be completed. All prescribed fee is to be deposited as per instructions Department No.- S-5/01, Pay Scale:-56,100-1,77,500,
relevant information/ instructions shall be sent through provided in second stage. The prescribed fee for different Pay-Matrics level-10.
sms on that mobile number and e-mail through their categories is as under:- Academic Qualification:- (A) Essential Qualification- A
registered e-mail ID. This is also directed to the (i) Unreserved/ - Application fee Rs. 80/- + On-line candidate for Direct Recruitment to the post of Technical
Economically processing fee Rs. 25/- Total = Officer in the service must possess the following
candidates to check the Commission's website
Weaker Sections/ Rs. 105/- qualifications:- (1) A Bachelor's degree in Chemical
continuously for further updates. Engineering or Bio-chemical Engineering or Bio-
other Backward
NECESSARY INFORMATION TO APPLICANTS technology from a University or an institution established
FILLING THEIR APPLICATIONS THROUGH ON-LINE Classes
(ii) Scheduled Castes/ - Application fee Rs. 40/- + On-line by law in India with qualified Graduate Aptitude Test in
This advertisement is also available on the Engineering (GATE) in concerned branch/discipline; or (2)
Commission's website https://uppsc.up.nic.in. The Scheduled Tribes processing fee Rs. 25/- Total =
Masters Degree in Chemistry or Bio-chemistry or
On-line application system is applicable for applying Rs. 65/-
Microbiology from a University or an institution
against this advertisement. Applications sent by any (iii) Handicapped - Application fee NIL/- + On-line established by law in India with qualified Graduate
other mode shall not be entertained hence candidates processing fee Rs. 25/- Total = Aptitude Test in Engineering (GATE) in concerned
are advised to apply On-line only. In connection with Rs. 25/- subject/discipline. (B) Preferential Qualification- A
On-line application, candidates are advised to go (iv) Ex-Servicemen - Application fee Rs. 40/- + On-line candidates who has: (1) served in the territorial army for a
through the instructions thoroughly given as under processing fee Rs. 25/- Total = minimum period of two years. or (2) obtained "B" certificate
and apply accordingly:- Rs. 65/- of National cadet corps, shall, other things being equal, be
1. When the candidate clicks "ALL NOTIFICATIONS/ (v) Dependents of the - According to their original given preference in the matter of direct recruitment. Note-
ADVERTISEMENTS" on the Commission's website Freedom Fighters/ category (1) The recruitment for the post of Technical Officer shall be
https://uppsc.up.nic.in the On-line advertisements shall done by commission through Marks given on the basis of
Women
be automatically displayed, wherein there shall be 3 parts the score obtained in the Graduate Aptitude Test in
given as below : 3. If the claims of the candidates made in their applications
Engineering (GATE) in concerned Branch/Subject as
are not found true, they can be debarred from all the future
(i) User instructions mentioned in Academic Qualification and total marks in
examinations and selections made by the Commission
(ii) View Advertisement interview decided by commission. (2) Candidates will have
including other appropriate penalties.
(iii) Apply to annex self attested copies of all session's marksheets
4. Modify Submitted Application: If a candidate comes essentially along with self attested copies of all other
The Instructions for filling "On-line form" have been given to know about any error/errors in the submitted application
in User Instruction. The Candidates desirous to see the required certificates, at the time of demand of records. Age
form except in the name of exam and type of recruitment. Limit:- 21 to 40 years.
respective advertisement will have to click on 'View Registered Mobile Number, E-mail ID, Aadhaar Number
Advertisement'. Thereafter, a full advertisement will be Uttar Pradesh Geology and Mining Department
and such cases where prescribed fee for modified
displayed alongwith sample snapshots of On-line category is higher (in case of error in these entries, 01 Post (Unreserved) of Assistant Drilling Engineer,
Application procedure. Click on "Apply" for On-Line candidate may submit new online application with Group-B, Nature of Post:- Gazetted, Reservation:-
Application. prescribed fee only as previously deposited fee will neither According to the existing Govt. Orders, Department No.-
On-line application will be completed in three stages : be adjusted nor refunded) he/she will be given only one S-6/1, Pay Scale:- Pay-Matrics level-10 (56,100-
First Stage:- On clicking "Apply" Candidate Registration opportunity to modify it/them according to the following 1,77,500), Academic Qualification:- (A) Essential
will be displayed. Basic Registration form will be displayed procedure before the last date of the submission of Qualification- Degree in Mining or Mechanical
on clicking the 'Candidate Registration' in respect to the application form. "Candidate has to click on 'Modify Engineering from a University established by law in India
Direct Recruitment. After filling the Basic Registration Submitted Application' under Online application process' with at least two years practical experience in diamond
form, the candidates must check all the informations filled in Candidate Segment. After that ' Candidate Personal drilling in various rock formations. (B) Preferential
by them. If any correction/modification is required, click on Details' will be displayed on the screen to fill in Registration Qualification- A candidate other things being equal, be
'Edit' button option and ensure the required corrections/ No., Date of Birth, Gender, Domicile and Category. After given preference in the matter of recruitment, if he- (1) has
modifications. After being fully satisfied with all the filling the Verification code the candidate has to click on the served in the Territorial Army for a minimum period of two
informations filled, click on 'Submit Application' 'proceed' button following which for Authentication of the years; or (2) has obtained a 'B' certificate of National Cadet
consequently, the registration of first stage shall be over. candidate OTP (One Time Password) will be sent on the Corps. Note- Candidates will have to annex self attested
Thereafter 'Print Registration Slip' shall be displayed registered mobile no. of the candidate and the Option-Box copies of all session's mark sheets essentially along with
and Print of Registration Slip must be taken by Clicking on will be displayed on the screen to fill in the OTP. After the self attested copies of all other required certificates, at the
Print Registration Slip. candidate has filled in the OTP and clicks on the 'proceed' time of demand of records. Age Limit:- 21 to 40 years.
Second Stage:- After the completion of the procedure of button his/her previously submitted on line application Uttar Pradesh AYUSH (Ayurvedic) Department
first stage, 'Fee to be deposited [in INR]' shall be displayed from will be displayed on the screen. The candidate can 04 Posts (Unreserved) of Principals - Government
with caption "Click here to proceed for payment". After submit his/her on line application form after making Ayurvedic Medical Colleges of the State, AYUSH
clicking the above caption of "Click here to proceed for required modifications in it. This facility will be available to Department (Ayurvedic), Nature of Post:- Gazetted,
payment", home page of State Bank MOPS (Multi Option the candidates only one time within the last date of Reservation:- According to the existing Govt. Orders,
Payment System) shall be displayed comprising of 03 submission of application form." Department No.- S-09/01, Pay Scale:- Pay-Matrics
modes of payment viz. Note: After scrutiny of online application if it is found Level-13 (Rs. 123100-215900), Academic Qualification:-
(i) NET BANKING (ii) CARD PAYMENTS and (iii) by the commission that the candidate has submitted (A) Essential Qualification- (1) Five years Degree in
OTHER PAYMENT MODES. more than one application form, in such a case, only Ayurveda from a University established by law, or Five
After payment of the required fee by any one of the above last submitted application form of the candidate will years degree from the Board of Indian Medicine, Uttar
prescribed modes, "Payment Acknowledgement Receipt be accepted and the remaining application forms will Pradesh, or from any other State Board or Faculty which is
automatically stand cancelled as application registrable under the United Provinces Indian Medicine
(PAR)" shall be displayed alongwith detail of fee payment,
modification option has already been provided in Act, 1939. (2) Twelve years Teaching experience (Ten
the print of which must be taken by clicking on "Print
years only in case of a Post-Graduate) including at least
Payment Receipt". foregoing para, therefore, in this regard no claim of the
five years administrative experience as Professor or as
Third stage :- On completion of the procedure of second candidate will be accepted.
Head of the Department. (3) Working knowledge of Hindi,
stage click on "Proceed for final submission of application Prohibition (Excise) Department, U.P. English and Sanskrit. (B) Preferential- (1) Post
form" as a result of which 'format' shall be displayed. The 02 Posts (Unreserved) of Regional Prohibition and Graduate qualification from a recognized Institution.

Page-1
(2) Research work and publication of Original Papers and question. For each question for which a wrong answer qualifications in terms of the advertisement.
books. (C) Other Preferential Qualification- (1) Served in has been given by the candidate, one third (0.33) of the 15. In the category of dependants of the freedom fighters
the territorial Army for a minimum period of two years; or marks assigned to that question will be deducted as only sons, daughters, grand-sons (son's son/daughter's
(2) Obtained a "B" certificate of National Cadet Corps; shall penalty. son) and grand daughters (son's daughter/daughter's
other things being equal be given preference in the matter (ii) If a candidate gives more than one answer, it will be daughter, married/ unmarried) are covered. Only such
of direct recruitment. Note- (1) Candidates will have to
treated as a wrong answer even if one of the given answer relationships with the freedom fighters are not adequate
mention their obtained marks and total marks of all
semesters in online application and annex all semesters happens to be correct and there will be same penalty as but the candidate should remain actually dependant of the
marksheet (in which maximum marks/minimum marks/ above for that question. freedom fighter. It is advised that now the candidates may
obtained marks should be clearly mentioned) essentially (iii) If a question is left blank i.e. no answer is given by the obtain the reservation, certificate from the District
alongwith other all certificates, at the time of demand of candidate, there will be no penalty for that question. Magistrate in terms of Govt. Order No. 453/79-V-1-15-
records. (2) Candidates must necessarily attach a copy of 8. The original certificates are required for verification at 1(Ka)/14-2015 dated 07-04-2015 in the prescribed format
the certificate/marksheet relating to the confirmation of the time of interview. Candidate will then also be required and submit the same.
working knowledge of Hindi, English and Sanskrit in to submit his/her passport size photograph attested by 16. In the event of involvement of a candidate in the
essential Qualification No.-3. (3) Experience certificate head of department or head of the institution, where he/she concealment of any important information, pendency of
should be of full time paid post in an institution recognized received last education or by a Gazetted Officer. any case/criminal case, conviction, more than a husband
by Government and issued by appointing authority and it 9. Candidates serving under Central or State Government or wife being alive, submission of facts in a distorted
should be countersigned by Registrar/Director of State manner, canvassing for selection etc. The Commission
will have to produce "NO OBJECTION CERTIFICATE"
Ayurvedic Medical Council or by a competent authority of
from their employer at the time of interview. reserves the right to reject the candidature and debar from
the Government. Experience of unpaid or part time post will
not be acceptable. Age Limit:- Minimum 35 years, 10. The decision of the Commission as to the eligibility or appearing in the examinations and selections.
Maximum 50 years (age relaxation as per Rules). otherwise of a candidate will be final. 17. The change of address intimation may be sent
Uttar Pradesh AYUSH (Homoeopathy) Department 11. The candidate coming under the reserved category, immediately to the Commission. In order to make any
06 Posts (03- Unreserved, 02- OBC, 01- SC) of Principals desiring benefit of the reservation, must indicate in the correspondence with the Commission, it is essential to
- Government Homoeopathic Medical Colleges of the prescribed column of the on-line application the category/ mention the name of the post applied for, advertisement
State, Nature of Post:- Gazetted, Reservation:- sub category (one or more than one) whatever may be, number, Deptt. No., date of birth and registration number.
According to existing Govt. Orders, Department No.- S- and if they fail to do so, they will be treated like a general 18. Candidates are required to hold essential qualification
11/01, Pay Scale:- Pay Matrics Level-13 (Rs. 123100- candidate and the benefit of reservation will not be till the last date of receipt of On-line application.
215900), Academic Qualification:- (A) Essential admissible to them. 19. The claim of category, subcategory, domicile, gender,
Qualification- Post Graduate qualification in 12. Till the last date and time of the submission of the on- date of birth, name and address will be valid only till the last
Homoeopathy and holding a post of not less than the line application, it is must to click the 'Submit Button'. The date of online application. In this regard no application for
teaching cadre of Professor in a Degree level candidate must take a print out of the application duly filled error correction/modification shall be acceptable.
Homoeopathic College for atleast two years. The in and keep it safe and secure. In the event of any Incomplete application form shall be summarily rejected
qualification shall be the one included in Second discrepancy, the candidate will be required to submit the and no correspondence shall be entertained in this regard.
Schedule of Homoeopathy Central Council Act. 1973. (B) On submission of false/misleading information, the
print-out to the office of the Commission otherwise the
Desirable Qualification- Degree/Diploma in Administrative/
request of the candidate shall not be entertained. candidature will be cancelled.
Health Administration from any recognised Institution.
Experience as Supervisor/Guide for Post Graduate 13. With regard to claims made in the 'On-line Application', 20. In case the candidates feel any problem in the "On-line
Programmed in Homoeopathy and original publication in the candidate shall submit the following original certificate/ Application" they may get their problem resolved by
research. Note- (1) Candidates will have to annex self certificates in the prescribed format, when asked for by the sending their quarries to the 'Mail Box' of the Commission.
attested copies of all sessions' marksheets essentially Commission. If the certificates are not submitted in time, Appendix-1 The procedure relating to upload photo &
alongwith self attested copies of all other required the candidature shall be cancelled. signature.
certificates, at the time of demand of records. (2) 13.1 Only Higher Secondary/High School Certificate for Detailed Application Form:
Experience certificate should be of full time paid post in proof of the age shall be treated valid. At the top of the page there is a 'Declaration' for the
an institution recognized by Government and issued by 13.2 Proof of degree/diploma or its equivalent candidates. Candidates are advised to go through the
appointing authority and it should be countersigned by qualifications to confirm the prescribed essential and contents of the Declaration carefully. Candidate has the
Registrar/Director of State Homoeopathic Medical preferential qualifications. option to either agree or disagree with the contents of
Council or by a competent authority of the Government. 13.3 In the case of physically handicapped candidates, the Declaration by clicking on 'I Agree' or 'I do not agree'
Experience of unpaid or part time post will not be certificate issued by the competent authority in the format- buttons. In case the candidate opts to disagree, the
acceptable. Age Limit:- Minimum 35 years, Maximum 50 application will be dropped and the procedure will be
1 to the Govt. Order No. 05/2022/18/1/2008/47/ka-2/2022
years (age relaxation as per Rules). Provided further that
dated 18th April 2022. terminated. Accepting to agree only will submit the
in the case of exceptionally qualified candidates the
13.4 In the case of the skilled players of the classified candidate's Online Application.
Governor may relax the prescribed age limit in
consultation with the Commission. sports, a certificate issued by the competent authority will Notification Details:-
GENERAL INSTRUCTIONS be required in terms of the Government Order No. – 22/21/ This section shows information relevant to Notification i.e.
LAST DATE FOR THE PAYMENT OF 1983-Ka-2 dated 28th November 1985. Notification number, selection type, directorate/
13.5 Under any reserved category/categories, for the department name and post name.
APPLICATION FEE IN THE BANK : 02-03-2023
confirmation of the claim for reservation, the caste Personnel Details :-
LAST DATE FOR SUBMISSION OF ONLINE
certificate issued by District Magistrate/Additional District This section shows information about candidate personnel
APPLICATIONS : 06-03-2023 Magistrate (Executive)/City Magistrate/SDM/Tehsildar in details i.e. Registration Number, candidate name, Father/
1.The candidate must carefully study the detailed the prescribed format prescribed under Govt. Order No. Husband name, Gender, DOB, UP domicile, Category,
advertisement and may apply for the post only when he/ 22/16/92-TC-III/Ka-2/2002 dated 22nd October, 2008 Marital status, email and contact number.
she is eligible for the concerned post. in respect of candidates belonging to the SC/ST/OBC, will OTHER DETAILS OF CANDIDATE :-
2. In no circumstance, applications shall be accepted after be accepted . Other details of candidate shows the information details
the last prescribed date and time. Applications found without 13.6 mRrj izn's k 'kklu] dkfeZd vuqHkkx&2 ds i=kad 1@2019@ about UP Freedom Fighter, Ex Army, service duration and
requisite informations and without photograph and 4@1@2002@dk&2@19 Vh-lh-&AA fnukad 18 Qjojh 2019 esa your physical challenges
signature, even when received in time, will be summarily fufgr izkfo/kkuksa ds vuqikyu esa mRrj izn'
s k jkT; ds ewy fuoklh ,oa Education & Experience details :-
rejected. vkfFkZd :i ls detksj oxksZa ds ,sls O;fDr;ksa tks vuqlwfpr tkfr] It shows your educational and experience details.
3. The knowledge of Hindi is essential. vuqlwfpr tutkfr rFkk vU; fiNM+s oxksZa ds fy, vkj{k.k dh orZeku Candidate address, photo & signature details :-
4. The date of calculation of age (except where O;oLFkk ls vkPNkfnr ugha gSa] dks mRrj izn'
s k ljdkj dh yksd Here you will see your complete communication address
indicated otherwise) is 1st July, 2023. The maximum age- lsokvksa vkSj inksa dh lHkh Jsf.k;ksa esa lh/kh HkrhZ ds izØe ij 10 and photo with your signature.
limit shall be relaxable by five years for the candidates izfr'kr dk vkj{k.k fu;ekuqlkj ns; gksxkA Declaration segment
belonging to Scheduled Caste, Scheduled tribe, Other 13.7 Those candidates, willing to take the benefit of the At the bottom of the page there is a 'Declaration' for the
backward class, Skilled players of U.P. of Classified reservation may obtain a certificate, issued by the candidates. Candidates are advised to go through the
games (for the post of Group 'B' and 'C' only) (Only competent authority, in support of the reserved category, in contents of the Declaration carefully.
domiciled persons of U.P. are entitled for such age the prescribed format printed in this detailed After filling all above particulars there is provision for
relaxation) and State Govt. Employees of U.P. including advertisement and submit the same to the Commission, preview your detail before final submission of application
Teachers/ Staff of the Basic Shiksha Parishad of U.P. whenever required to do so. Those claiming more than one form on clicking on “Preview” button.
according to G.O. No. 1648/79-5-2015, dated 19 June, reserved category will be given only one such concession, Preview page will display all facts/particulars that you have
2015 and Teachers/Staff of the Government Aided which will be more beneficial. The candidates not originally mentioned on entry time if you are sure with filled details
Madhyamik Vidyalayas of U.P. as per G.O. No. 1508/15- domiciled in U.P. belonging to SC, ST, O.B.C., dependants then click on “Submit” button to finally push data into server
8-2015-3057, dated 16 September, 2015. The upper age of freedom fighters, handicapped and Ex-servicemen are with successfully submission report that you can print.
limit shall also be greater by 3 years + period of service not entitled to benefit of reservation. Such candidates will Otherwise using “Back” button option you can modify
rendered in army for the emergency commissioned be treated in general category. your details.
officers/short service commission officers/commissioned veesš:- MeemeveeosMe mebKÙee-39 efjš/keâe-2/2019 efoveebkeâ - 26 petve, 2019 [CANDIDATES ARE ADVISED TO TAKE A PRINT OF
officers/Ex-Army personnels of U.P. It is essential to be
discharged from army upto the date of last date of receipt
Éeje MeemeveeosMe mebKÙee- 18/1/99/ keâe-2/2006 efoveebkeâ 09 peveJejer, THIS PAGE BY CLICKING ON THE “Print” OPTION
2007 kesâ Øemlej-4 ceW efoÙes ieÙes ØeeefJeOeeve, ‘‘Ùen Yeer mhe° efkeâÙee peelee nw AVAILABLE]
of application. Relaxation of 15 years in the upper age
efkeâ jepÙeeOeerve ueeskeâ mesJeeDeeW Deewj heoeW hej meerOeer Yeleea kesâ Øe›eâce hej For other information candidates are advised to select
limit will be admissible to P.H. candidates.
desired option in 'Home Page' of Commission's website
5. After receipt of application in the Commission, any ceefnueeDeeW keâes DevegcevÙe Ghejesòeâ Deej#eCe kesâJeue Gòej ØeosMe keâer cetue http://uppsc.up.nic.in in CANDIDATE SEGMENT
request for change in the qualification and category will not efveJeemeer ceefnueeDeeW keâes ner DevegcevÙe nw’’ keâes efjš ÙeeefÛekeâe mebKÙee- CANDIDATE SEGMENT
be entertained.
11039/2018 efJeefheve kegâceej ceewÙee& Je DevÙe yeveece Gòej ØeosMe jepÙe Je NOTIFICATIONS / ADVTS.
6. Minimum educational qualification is not sufficient for
being called for interview. Mere eligibility does not entitle a DevÙe leLee mecyeæ 6 DevÙe efjš ÙeeefÛekeâeDeeW ceW cee0 GÛÛe vÙeeÙeeueÙe, All Notification / Advertisements
candidate to be called for interview or for selection. Fueeneyeeo Éeje efoveebkeâ 16.01.2019 keâes DeefOekeâejeleerle (Ultra Vires) ONLINE FORM SUBMISSION
1. Candidate Registration
Intimation for interview will be sent later on. Ieesef<ele keâjves mecyevOeer efveCe&Ùe kesâ Devegheeueve ceW MeemeveeosMe efoveebkeâ
7. In case of large number of applicants for the post/ posts, 2. Fee Deposition /Reconciliation
09.01.2007 mes Øemlej-04 keâes efJeueesefhele efkeâS peeves keâe efveCe&Ùe efueÙee ieÙee 3. Submit Application Form
the Commission may hold screening test, which will nw~ Gòeâ efveCe&Ùe Meemeve Éeje cee0 GÛÛe vÙeeÙeeueÙe kesâ DeeosMe efoveebkeâ
be communicated in due course of time. Under the APPLICATION FORM STATUS
conditions of holding screening test (Objective Type),
16.01.2019 kesâ efJe™æ oeÙej efJeMes<e Deheerue ([er) mebKÙee-475/2019 ceWb Update your transaction ID by Double Verification mode
penalty (Negative Marking) shall be imposed for wrong cee0 vÙeeÙeeueÙe Éeje heeefjle nesves Jeeues Deefvlece efveCe&Ùe kesâ DeOeerve nesiee~ View Application Status
answers given by the candidates in the manner given 14. The Commission do not advise to candidates about List of Applications Having photo related Objections
below-- their eligibility. Therefore, they should carefully read the Print Duplicate Registration Slip
(i) There are four alternatives for the answer to every advertisement and apply only when satisfied about their Print Detailed Application Form

Page-2
EXAMINATION SEGMENT uxj ------------------------ ftyk ------------------------ esa lkekU;r;k jgrk gSA office_________ District________State__________.
Print Address Slip for sending documents to Commission LFkku -------------------------- gLrk{kj ----------------------------- whose photograph is affixed above, and am satisfied that:
[Only for Direct Recruitment ] fnuakd ----------------------- iwjk uke ----------------------------- (A ) he/she is a case of:
DOWNLOAD SEGMENT
eqgj --------------------------- in uke ----------------------------- n Iocomotor disability
Download Document of Verification for this Examination
Download Admit Card ftykf/kdkjh@vfrfjDr ftykf/kdkjh@flVh eftLVsªV@ijxuk n dwarfism
eftLVsªV@rglhynkjA
Download Interview Letter : After Examination n blindness
Download Interview Letter : Direct Recruitment ¼çi=&I½ (Please tick as applicable)
Download Syllabus mRrj çns'k ljdkj
(B) The diagnosis in his/her case is_________
Know your Registration No. dk;kZy; dk uke----------------------------------------------
(A) he/she has ________% (in figure)________percent
Click here to view Key Answer Sheet
vkfFkZd :i ls detksj oxZ ds lnL; }kjk izLrqr fd;k tkus (in words) permanent locomotor disability/
Latest Tenders
okyk vk; ,oa ifjlEifRr izek.k&i= dwarfism/blindness in relation to his/her______
LAST DATE FOR RECEIPT OF APPLICATIONS : On- line
çek.k i= la[;k------------------- fnukad --------------------
(part of body) as per guidelines (.............number
Application process must be completed (including filling
and date of issue of the guidelines to be specified).
up of Part-I, Part-II and Part-III of the Form) before last foRrh; o"kZ ---------------- ds fy, ekU;

date of form submission according to Advertisement, after 2. The applicant has submitted the following document
çekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh------------------------------
which the weblink will be disabled. as proof of residence:-
----------- iq=@ifr@iq=h----------------------------------- xzke@dLck----------------------------
Appendix-1 iksLV vkWfQl ---------------------------- Fkkuk ------------------------------ rglhy -------------------- Nature of Date of Details of authority
The Procedure relating to upload Photo & Signature. -------- ftyk ------------------------------------ jkT; -------------------------- fiu dksM ----------------
Document Issue issuing certificate
Guide Lines for Scanning Photograph with Signature ------- ds LFkk;h fuoklh gSa] ftudk QksVksxzkQ uhps] vfHkçekf.kr gS]
1. Paste the Photo on any white paper as per the below vkfFkZd :i ls detksj oxZ ds lnL; gSa] D;ksafd foRrh; o"kZ ------------------ 3. Signature and seal of the Medical Authority.
required dimensions. Sign in the Signature Space -- esa buds ifjokj dh dqy okf"kZd vk; 8 yk[k ¼vkB yk[k :i;s ek=½
provided. Ensure that the signature is within the box. (Dr...............) (Dr...............) (Dr...............)
ls de gSA buds ifjokj ds LokfeRo esa fuEufyf[kr esa ls dksbZ Hkh
2. Scan the below required size containing photograph and ifjlEifRr ugha gS%&
Member Member Chairperson
signature. Please do not scan the complete page. I. 5 ¼ikWp
a ½ ,dM+ d`f"k ;ksX; Hkwfe vFkok mlls ÅijA
Medical Board Medical Board Medical Board
3. The entire image (of size 3.5 cm by 6.0 cm) consisting of with seal with seal with seal
II. ,d gtkj oxZ QhVvFkok blls] vf/kd {ks=Qy dk ¶ySVA
the photo along with the signature is required to be
III. vf/klwfpr uxjikfydk ds varxZr 100 oxZ xt vFkok Signature/thumb
scanned, and stored in * .jpg, .jpeg, .gif, .tif, .png format on impression of the Countersigned by the
blls vf/kd dk vkoklh; Hkw[k.MA
local machine. person in whose
IV. vf/klwfpr uxjikfydk ls brj 200 oxZ xt vFkok blls
Chief Medical Officer
4. Ensure that the size of the scanned image is not more favour certificate of
than 50 KB. vf/kd dk vkoklh; Hkw[k.MA (with seal)
disability is issued
5. lf the size of the file is more than 50 KB, then adjust the 2- Jh@Jherh@dqekjh -------------------------------------- tkfr ------------------- ds

settings of the scanner such as the DPI resolution, colours lnL; gSa tks vuqlfw pr tkfr] vuqlfw pr tutkfr rFkk vU; fiNM+s Form-III
etc., during the process of scanning. oxksZa ds :i esa vf/klwfpr ugha gSA
a
Certificate of Disability
6. The applicant has to sign in full in the box provided. Since (In cases of multiple disabilities)
gLrk{kj ------------------¼dk;kZy; dk eqgj lfgr½
the signature is proof of identity, it must be genuine, and in vkosnd dk iwjk uke ------------------------------------------------------------------
(Name and Address of the Medical Authority/Board
full; initials are not sufficient. Signature in CAPITAL ikliksVZ lkbt issuing the Certificate)
inuke --------------------------------------------------------------------
LETTERS is not permitted. dk vfHkizekf.kr Recent passport size
ftykf/kdkjh@vfrfjDr ftykf/kdkjh@flVh
7. The signature must be signed only by the applicant and attested photograph
QksVksxzkQ
not by any other person. eftLVªV
s @ijxuk eftLVªV
s @rglhynkjA
(showing face only) of
8. The signature will be used to put on the Hall Ticket and ¼çi=&II½
the person with disabiliy
wherever necessary. If the Applicant’s signature on answer vkfFkZd :i ls detksj oxZ ds ykHkkFkZ Lo;a ?kks"k.kk i=

script, at the time of the examination, does not match the Cerficate No. Date:
Lo;a ?kks"k.kk i=
signature on the Hall Ticket, the applicant will be eSa ------------------ iq=@iq=h@iRuh ------------------- xzke@dLck -----------
This is to certify that we have carefully examined
disqualified. Shri/Smt./Kum.___________son/wife/ daughter of
------- iksLV vkWfQl ------------------------------ Fkkuk ----------------------- Cykd ---------------
Sample Image & Signature :- Shri _____________ Date of birth (DD/MM/ YY) _______
--- rglhy ----------------------------- ftyk ----------------------- jkT; ------------------------------
age_____ years, male/ female__________.
--------- us vkfFkZd :i ls detksj oxZ ds çek.k i= gsrq vkosnu fn;k gS]
Registration No.__________ permanent resident of
,rn~ }kjk ?kks"k.kk djrk@djrh gw¡A
House No._________ Ward/Village/Street________
1 . eSa -------------------------------------------- tkfr ls lEcU/k j[krk@j[krh g¡]w tks
Post Office_______District________ State_______,
mRrj izn'
s k gsrq vf/klwfpr vuqlfw pr tkfr] vuqlfw pr tutkfr]
whose photograph is affixed above, and am satisfied that:
,oa vU; fiNM+k oxZ dh lwph esa lwphc) ugha gSA
(A) he/she is a case of Multiple Disability. His/her extent of
2- esjs ifjokj dh dqy Jksrksa ¼osru] d`f"k] O;olk;] is'kk bR;kfn½
permanent physical impairment/disability has been
ls dqy okf"kZd vk; : ------------------------ ¼'kCnksa es½
a gSA
evaluated as per guidelines (......number and date of issue
3- esjs ifjokj ds ikl mfYyf[kr vk; ds flok; vFkok blds
of the guidelines to be specified) for the disabilites ticked
ifjf'k"V vfrfjDr vU;= dksbZ ifjlEifRr ugha gSA

vFkok
below, and is shown against the relevant disability in the
m0iz0 dh vuqlwfpr tkfr rFkk vuqlwfpr tutkfr ds fy;s Permanent
dbZ LFkkuksa ij fLFkr ifjlEifRr;ksa dks tksMu
+ s ds i'pkr Hkh eSa ¼uke½ ---
tkfr izek.k&i= ¼izk#i& ½ II Affected physical
------------------------------ vkfFkZd :i ls detksj oxZ ds nk;js esa S. Diagno impairment/
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ------------------
part of
vkrk@vkrh g¡A
w N. Disability sis mental disability
lqiq=@lqiq=h Jh ------------------------ fuoklh ----------------- xzke -------- rglhy
body
4- eSa ?kks"k.kk djrk@djrh g¡w fd esjs ifjokj dh lHkh (in%)
---------------- uxj ------------------------ ftyk -------------------------- mRrj izn'
s k jkT; ifjlEifRr;ksa dks tksMu
+ s ds i'pkr~ fuEufyf[kr esa ls fdlh Hkh
1. Locomotor disability @
dh ------------------------- tkfr ds O;fDr gSa ftls lafo/kku ¼vuqlwfpr tkfr½ lhek ls vf/kd ugha gSA
2. Muscular Dystrophy
vkns'k] 1950 ¼tSlk fd le;&le; ij la'kksfèkr gqvk½@lafo/kku
I. 5 ¼ikWp
a ½ ,dM+ d`f"k ;ksX; Hkwfe vFkok mlls ÅijA
¼vuqlwfpr tutkfr] mRrj izn'
s k½ vkns'k] 1967 ds vuqlkj
3. Leprosy cured
II. ,d gtkj oxZ QhV vFkok blls] vf/kd {ks=Qy dk ¶ySVA
vuqlwfpr tkfr@vuqlwfpr tutkfr ds :i esa ekU;rk nh xbZ gSA 4. Dwarfism
III. vf/klwfpr uxjikfydk ds varxZr 100 oxZ xt vFkok blls
Jh@Jherh@dqekjh ------------------------------------------------- rFkk@vFkok vf/kd dk vkoklh; Hkw[k.MA
5. Cerebral Palsy
mudk ifjokj mRrj izn'
s k ds xzke ---------------------- rglhy ----------------------
IV. vf/klwfpr uxjikfydk ls brj 200 oxZ xt vFkok blls vf/kd
6. Acid attack Victim
uxj -------------------------- ftyk ---------------------- esa lkekU;r;k jgrk gSA
dk vkoklh; Hkw[k.MA
7. Low Vision #
LFkku -------------------------- gLrk{kj--------------------------- eSa çekf.kr djrk@djrh gw¡ fd esjs }kjk mijksDr tkudkjh esjs Kku vkSj
8. Blindness #
fnuakd ----------------------- iwjk uke-------------------------- fo'okl ds vuqlkj lR; gS vkSj eSa vkfFkZd :i ls detksj oxZ ds fy,

vkj{k.k lqfo/kk çkIr djus gsrq ik=rk /kkj.k djrk@djrh gw¡A ;fn esjs }kjk
9. Deaf £
eqgj --------------------------- in uke----------------------------
nh xbZ tkudkjh vlR;@xyr ik;h tkrh gS rks eSa iw.kZ :i ls tkurk 10. Hard of Hearing £
ftykf/kdkjh@vfrfjDr ftykf/kdkjh@flVh eftLVsªV@ijxuk
gw¡W@tkurh gw¡ fd bl vkosnu i= ds vk/kkj ij fn;s x;s çek.k i= ds }kjk 11. Speech and
eftLVsªV@rglhynkj@vU; osru Hkksxh eftLVsªV] ;fn dksbZ
'kS{kf.kd laLFkku esa fy;k x;k ços'k@yksd lsokvksa ,oa inksa esa izkIr dh xbZ Language disability
gks@ftyk lekt dY;k.k vf/kdkjhA
fu;qfDr fujLr dj nh tk;sxh@dj fn;k tk;sxk vFkok bl çek.k i= ds
12. Intellectual Disability
mÙkj izns'k ds vU; fiNM+s oxZ ds fy, tkfr izek.k&i= vk/kkj ij dksbZ vU; lqfo/kk@ykHk çkIr fd;k x;k gS mlls Hkh oafpr fd;k
13. Specific Learning
¼izk#i&I½ tk ldsxk vkSj bl lEcU/k esa fof/k ,oa fu;eksa ds v/khu esjs fo:) dh tkus
Disability
okyh dk;Zokgh ds fy, eSa mRrjnk;h jgw¡xk@jgw¡xhA
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ------------------ lqiq=@
uks V%& tks ykxw ugha gks mls dkV ns a A
14. Autism Spectrum
lqiq=h ------------------ fuoklh ------------------ rglhy ------------------ uxj -------------
Disorder
ftyk ----------------- mRrj izn'
s k jkT; dh -------------------- fiNM+h tkfr ds LFkku %& vkosnd@vkosfndk dk gLrk{kj rFkk iwjk ukeA

O;fDr gSaA ;g tkfr m0iz0 yksd lsok ¼vuqlwfpr tkfr;ksa] vuqlwfpr Form-II 15. Mental illness
tutkfr;ksa vkSj vU; fiNM+s oxksZa ds fy;s vkj{k.k½ vf/kfu;e] 1994 Certificate of Disability 16. Chronic Neurological
¼;Fkkla'kksf/kr½ dh vuqlwph&,d ds vUrxZr ekU;rk izkIr gSA (In cases of amputation or complete permanent paralysis Conditions
of limbs or dwarfism and in case of blindness) (Name and
;g Hkh izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ------------- 17. Multiple sclerosis
Address of the Medical Authority issuing the Certificate)
--------------- iwoksZDr vf/kfu;e] 1994 ¼;Fkkla'kksf/kr½ dh vuqlwph&nks 18. Parkinson's disease
tSlk fd m0iz0 yksd lsok ¼vuqlwfpr tkfr;ksa] vuqlwfpr tutkfr;ksa Recent passport size 19. Haemophilia
attested photograph
20. Thalassemia
vkSj vU; fiNM+s oxksZa ds fy;s vkj{k.k½ ¼la'kks/ku½ vf/kfu;e] 2001

}kjk izfrLFkkfir fd;k x;k gS ,oa tks m0iz0 yksd lsok ¼vuqlwfpr (showing face only) of
the person with disabiliy 21. Sickle Cell disease
tkfr;ksa] vuqlwfpr tutkfr;ksa vkSj vU; fiNM+s oxksZa ds fy;s

vkj{k.k½ ¼la'kks/ku½ vf/kfu;e] 2002 }kjk la'kksf/kr dh x;h gS] ls

Certificate No. Date: (B) In the light of the above, his/her over all permanent
vkPNkfnr ugha gSA buds ekrk&firk dh fujarj rhu o"kZ dh vof/k ds
This is to certify that I have carefully examined physical impairment as per guidlines (.......number and
fy;s ldy okf"kZd vk; vkB yk[k #i;s ;k blls vf/kd ugha gS rFkk
Shri/Smt./Kum._____________son/wife/daughter of date of issue of the guidelines to be specified), isfollows:In
buds ikl èkudj vf/kfu;e] 1957 esa ;Fkk fofgr NwV lhek ls vf/kd
Shri__________Date of Birth (DD/MM/YY)________Age figures................percent.
lEifRr Hkh ugha gSA
____years, male/female___________ registration No. In words............................................................percent
Jh@Jherh@dqekjh ------------------------------- rFkk@vFkok mudk
__________permanent resident of House No. 2. This condition is progressive/non-progressive/likely to
ifjokj mRrj izn'
s k ds xzke --------------------------- rglhy --------------------------
_ _ _ _ _ _ _ _ Wa r d / V i l l a g e / S t r e e t _ _ _ _ _ _ _ _ _ P o s t improve/not likely to improve.

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3. Reassessment of disability is:- Signature/thumb 4. Countersigned by the izek.k&i= Mhu vkWQ LiksV~lZ vFkok bapktZ [ksy dwn --------------------------

(i) not necessary, impression of the Chief Medical Officer -- fo'ofo|ky; esa miyC/k fjdkMZ ds vk/kkj ij fn;k x;k gSA

or person in whose (with seal) LFkku -------------------------- gLrk{kj --------------------------------------

(ii) is recommended/ after............ years............ months, favour certificate of
and therefore this certificate shall be valid till.... ...... ..... disability is issued fnuakd ----------------------- uke ---------------------------------------------

(DD) (MM) (YY) in ----------------------------------------------

Signature and seal of the
@ -e.g. Left/right/both arms/legs Medical Authority. laLFkk dk uke ---------------------------
# - e.g. Single eye
mÙkj izn'
s k yksd lsok ¼'kkjhfjd :Ik ls fodykax] Lora=rk laxzke eqgj --------------------------------------------
£ - e.g. Left/Right/both ears
lsukfu;ksa ds vkfJrksa vkSj HkwriwoZ lSfudksa ds fy;s vkj{k.k½] vf/kfu;e] uksV % ;g izek.k&i= fo'ofo|ky; ds Mhu vkWQ LiksV~lZ ;k bapktZ
4. The applicant has submitted the following document as
[ksy&dwn }kjk O;fDrxr :i ls fd;s x;s gLrk{kj gksus ij gh ekU;
proof of residence:- 1993 ¼;Fkkla'kksf/kr½ ds vuqlkj Lora=rk laxzke lsukuh ds vkfJr ds
gksxkA
izek.k&Ik= dk izi=A
Nature of Date of Details of authority izk:i & 4
izek.k&i=
Document Issue Issuing certificate
izekf.kr fd;k tkrk gS fd Jh@Jherh ------------------------ fuoklh ¼ekU;rk izkIr ØhM+k@[ksy esa vius Ldwy dh vksj ls jk"Vªh;

xzke& --------------- uxj& ------------------- ftyk& ---------------- mÙkj izn'

s k yksd [ksy&dwn esa Hkkx ysus okys f[kykM+h ds fy;s½
5. Signature and seal of the Medical Authority. lsok ¼'kkjhfjd :Ik ls fodykax] Lora=rk laxzke lsukfu;ksa ds vkfJrksa MkbjsDVªsV vkWQ ifCyd bUlVªD'kUl@funs'kd] f'k{kk] mÙkj
vkSj HkwriwoZ lSfudksa ds fy;s vkj{k.k½ vf/kfu;e] 1993 ds vuqlkj izn'
s k ------------------------------ jkT; Lrj dh lsokvksa@inksa ij fu;qfDr
Lora=rk laxzke lsukuh gSa vkSj Jh@Jherh@dqekjh ¼vkfJr½ ----------- ds fy, dq'ky f[kykfM+;ksa ds fy, izek.k&i=
Name and Seal Name and Seal Name and Seal iq=@iq=h@ikS= ¼iq= dk iq= ;k iq=h dk iq=½ rFkk ikS=h ¼iq= dh iq=h
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh -----------------------------------
of Member of Member of the Chairperson ;k iq=h dh iq=h½ ¼fookfgr vFkok vfookfgr½ mijkafdr vf/kfu;e]
-- vkRet@iRuh@vkRetk Jh ------------------------------------------- fuoklh
1993 ¼;Fkkla'kksf/kr½ ds izkfo/kkuksa ds vuqlkj mDr Jh@Jherh
Countersigned by the ¼iwjk irk½ ------------------------------------ esa ----------------------------- Ldwy esa d{kk ------
¼Lora=rk laxzke lsukuh½ ----------------ds vkfJr gSaA
Chief Medical Officer --------- ds fo|kFkhZ us fnukad ------------------- ls fnukad ------------------- rd ------
LFkku% gLrk{kj ----------------------------------- ------------¼LFkku dk uke½ esa vk;ksftr Ldwyksa ds us'kuy xsEl dh ----------
(with seal)
fnukad% iwjk uke ----------------------------------- -------------- ¼ØhM+k@[ksy&dwn dk uke½ izfr;ksfxrk@VwukZesUV esa ----------

inuke ------------------------------------- ----------------- Ldwy dh vksj ls Hkkx fy;kA muds Vhe ds }kjk mDr

izfr;ksfxrk@ VwukZesUV esa ------------------------- LFkku izkIr fd;k x;kA

eqgj ------------------------------------------
Form-IV
;g izek.k&i= MkbjsDVªsV vkWQ ifCyd bUlVªD'kUl@f'k{kk esa
Certificate of Disability ftykf/kdkjh
miyC/k fjdkMZ ds vk/kkj ij fn;k x;k gSA
(In cases of other than those mentioned in Forms II and III ) ¼lhy½
LFkku -------------------------- gLrk{kj -------------------------------------
(Name and Address of the Medical Authority/Board
issuing the Certificate) dq'ky f[kykfM+;ksa ds fy;s izek.k&i= tks m-iz- ds ewy fuoklh gSa fnuakd ----------------------- uke ---------------------------------------------

'kklukns'k la[;k&22@21@1983&dkfeZd&2 in ----------------------------------------------

Recent passport size
fnukad 28 uoEcj] 1985
attested photograph laLFkk dk uke --------------------------
izek.k&i= ds QkeZ & 1 ls 4
(showing face only) of eqgj -------------------------------------------
izk:i &1
the person with disabiliy uksV % ;g izek.k&i= funs'kd@;k vfrfjDr@la;qDr ;k
¼ekU;rk izkIr ØhM+k@[ksy esa vius ns'k dh vksj ls vUrjkZ"Vªh;
mifuns'kd MkbjsDVªsV vkWQ ifCyd bUlVªD'kUl@f'k{kk -------------------
Cerficate No. Date: izfr;ksfxrk esa Hkkx ysus okys f[kykM+h ds fy;s½
- }kjk O;fDrxr :i ls gLrk{kj gksus ij ekU; gksxkA
This is to certify that we have carefully examined lEcfU/kr [ksy dh jk"Vªh; QsMjs'ku@jk"Vªh; ,lksfl,'ku dk

Shri/Smt./Kum.___________son/wife/daughter of
Shri _____________ Date of birth (DD/MM/ YY) _______
uke --------------------------- jkT; ljdkj dh lsokvksa@inksa ij fu;qfDr ds

fy, dq'ky f[kykfM+;ksa ds fy, izek.k&i= izekf.kr fd;k tkrk gS fd

lfpo
age_____ years, male/ female__________. Jh@Jherh@dqekjh ------------------------ vkRet@iRuh@vkRetk Jh -------

-------------- fuoklh ---------------------- iwjk irk ----------------- us fnukad ------------------

Registration No.__________permanent resident of House
- ls fnukad ------------------ rd --------------------- ¼LFkku dk uke½ esa vk;ksftr--
No. ________ Ward/Village/ Street________Post
---------------------- ¼ØhM+k@[ksy&dwn dk uke½ dh izfr;ksfxrk@VwukZesUV
Office_______District________ State_______, whose
esa ns'k dh vksj ls Hkkx fy;kA
photograph is affixed above, and am satisfied that he/she is
a case of ___________ Disability. His/her extent of muds Vhe ds }kjk mDr izfr;ksfxrk@VwukZesUV esa -------------------------

percentage physical impairment/disability has been LFkku izkIr fd;k x;kA

evaluated as per guidelines (......number and date of issue ;g izek.k&i= jk"Vªh; QsMjs'ku@jk"Vªh; ,lksfl,'ku@¼;gk¡ laLFkk

of the guidelines to be specified) and is shown against the dk uke fn;k tk;s½ --------- esa miyC/k fjdkMZ ds vk/kkj ij fn;k x;k

relevant disability in the table below: gSA

LFkku -------------------------- gLrk{kj --------------------------------------

Permanent
Affected physical fnuakd ----------------------- uke ---------------------------------------------
S. part of Diagno impairment/ in -----------------------------------------------
N. Disability sis mental disability
body laLFkk dk uke ---------------------------
(in%)
eqgj --------------------------------------------
1. Locomotor disability @
uksV % ;g izek.k&i= us'kuy QsMjs'ku@us'kuy ,lksfl,'ku ds lfpo
2. Muscular Dystrophy }kjk O;fDrxr :i ls fd;s x;s gLrk{kj gksus ij gh ekU; gksxkA

3. Leprosy cured izk:i & 2

4. Cerebral Palsy ¼ekU;rk izkIr ØhM+k@[ksy esa vius izn'

s k dh vksj ls jk"Vªh;

5. Acid attack Victim izfr;ksfxrk esa Hkkx ysus okys f[kykM+h ds fy;s½

6. Low Vision # lEcfU/kr [ksy dh izn'

s kh; ,lksfl,'ku dk uke -------------------jkT;

ljdkj dh lsokvksa@inksa ij fu;qfDr ds fy, dq'ky f[kykfM+;ksa ds

fy, izek.k&i=

izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ---------------- vkRet@

9. Speech and
iRuh@vkRetk Jh ----------------------- fuoklh ¼iwjk irk½ -----------------------us
Language disability fnukad----------------ls fnukad-------------------rd-------------------esa

10.
Intellectual Disability ¼ØhM+k@[ksy&dwn dk uke½ dh izfr;ksfxrk ¼VwukZesUV LFkku dk uke½-

Specific Learning -------------------vk;ksftr jk"Vªh;--------------- esa ¼ØhM+k@[ksy&dwn dk uke½

11.

dh izfr;ksfxrk@ VwukZesUV esa izn'

s k dh vksj ls Hkkx fy;kA
Disability

muds Vhe ds }kjk mDr izfr;ksfxrk@VwukZesUV esa -------------------------

12. Autism Spectrum

LFkku izkIr fd;k x;kA

Disorder

;g izek.k&i= ------------------------------------- ¼izn'

s kh; la?k dk uke½ esa
13. Mental illness

miyC/k fjdkMZ ds vk/kkj ij fn;k x;k gSA

Chronic Neurological
14.
LFkku -------------------------- gLrk{kj --------------------------------------
Conditions

15. Multiple sclerosis

fnuakd ----------------------- uke ---------------------------------------------

16. Parkinson 's disease in ---------------------------------------------

17. Haemophilia laLFkk dk uke ---------------------------

18. Thalassemia eqgj --------------------------------------------

19. Sickle Cell disease

uksV % ;g izek.k&i= izn'
s kh; [ksy&dwn la?k ds lfpo }kjk

(Please strike out the disabilities which is not applicable) O;fDrxr :i ls fd;s x;s gLrk{kj gksus ij gh ekU; gksxkA

2. The above condition is progressive/non-progressive/ çk:i & 3

likely to improve/not likely to improve.
¼ekU;rk izkIr ØhM+k@[ksy esa vius fo'ofo|ky; dh vksj ls
3. Reassessment of disability is:- vUrfoZ'ofo|ky; izfr;ksfxrk esa Hkkx ysus okys f[kykM+h ds fy;s½
(i) not necessary, or
fo'ofo|ky; dk uke -------------------- jkT; Lrj dh lsokvksa@inksa
(ii) is recommended/after............years............
ij fu;qfDr ds fy, dq'ky f[kykfM+;ksa ds fy, izek.k&i=
months, and therefore this certificate shall be
valid till.... ...... ..... (DD) (MM) (YY) izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ---------------------

vkRet@iRuh@vkRetk Jh ---------------------------- fuokl ¼iwjk uke½ ---------

@ - e.g. Left/right/both arms/legs
------------------------------ fo'ofo|ky; dh d{kk ---------------------------- ds fo|kFkhZ
# - e.g. Single eye/both eyes
us fnukad ----------------------- ls fnukad --------------------- rd -----------------------
£ - e.g. Left/Right/both ears
¼LFkku dk uke½ esa vk;ksftr vUrfoZ'ofo|ky; ----------------------------

¼ØhM+k@ [ksy&dwn dk uke½ izfr;ksfxrk@VwukZesUV esa --------------------------

Name and Seal Name and Seal Name and Seal fo'ofo|ky; dh vksj ls Hkkx fy;kA muds Vhe ds }kjk mDr

of Member of Member of the Chairperson izfr;ksfxrk@VwukZesUV esa ------------------------- Lfkku izkIr fd;k x;kA ;g

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