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‘Annoxure-1
Solf-declaration Certificate for Com Ietion of Journe
(Annexure to O.M. No, 19024/03/[Link] dated 16.06.2022)
4. 1 (Name of the employee. ee ) hereby declare and
certity that
2. 1 have actually performed the onward journey from. oe to
00) (date) and return journey
from. 40.0 on for the purpose of
TouriTrining,
oR
3. We have actually performed the onward joumey from. . 10
on, (date) and return journey
from, to, on, for the purpose of
Transfer TCiRetrement. The particulars of the self and famly members who have performed journey
either wih the Government servant or separately areas under
[Link]. Name Age
4 In case the above declaration given by me is not found true at any stage, | shall be liable to
disciplinary action under Central Civil Services (Classification, Control and Appeal) Rules, 1965, as
‘amended from time to ime
(Signature)
Name of the Government servant.
Designation.
Name of the Ministry/Department.
To
Admin/Estabishment Section
Ministry/Departmert..