APPENDIX – I
Certificate regarding physical limitation in an examinee to write
This is to certify that, I have examined Mr/Ms/Mrs_________________________(name of the
candidate with disability) a person with (nature and percentage of disability as mentioned in
the certificate of disability), S/o, D/o ______________________________, resident of
(Village/District/State) and to state that he/she has physical limitation which hampers
his/her writing capabilities owing to his/ her ability.
Signature(Medical Officer/ Chief Medical Officer of Government
Hospital)
Name:
Designation: Seal
Place:
Date:
Note:
Certificate should be given by a specialist of the relevant stream/disability (eg. Visual
impairment-Ophthalmologist, Locomotor disability-Orthopaedic specialist).
DECLARATION BY THE CANDIDATE
(Scribe Certificate to be uploaded in Online application portal)
I _____________________________________S/o / W/o / D/o.
___________________________________________________
R/o__________________________________________________________________________________________________
applicant for the post of ______________________________________________________ hereby declare that
Mr./Ms. _______________________________ S/o, W/o, D/o ___________________________________, R/o
______________________________________________________________________________________ has agreed on
my request to act as my scribe for the Selection.
DECLARATION BY THE SCRIBE / WRITER
I _____________________________________S/o / W/o / D/o.
___________________________________________________
R/o ________________________________________________________________________________ holder of
identification ________________________________________________________________ have agreed to act as
scribe for Mr./Ms. _____________________________________________ S/o / W/o / D/o.
__________________________________ the Blindness / Locomotor Disability (Both Arm) / Cerebral Palsy
candidate for the post of _____________________________).
I declare that my educational qualification as on date ________________ is (Tick the box):
Below Matriculation Matriculation 10+2 Graduate Post Graduate
Space for pasting Space for pasting
of recent passport of recent passport
size photograph of size photograph of
Scribe to be cross Candidate to be
self attested cross self attested
If the above declaration is found false, I shall be If the above declaration is found false, I shall be solely
solely responsible for the consequences and loss responsible for the consequences. I am engaging the
suffered by the candidate. above scribe at my own cost and risk. I Understand that
if the declaration of the scribe is found false, I may be
debarred from the examination.
Signature of Scribe Signature of the Candidate
SCRIBE DECLARATION FORM
GUIDELINES REGARDING PERSONS WITH DISABILITIES
Those candidates with Blindness / Locomotor Disability (Both Arm) / Cerebral Palsy and/or whose
writing speed is affected permanently for any reason can use own scribe at own cost during the
examination. In all such cases where a scribe is used, the following rules will apply:
1.0 Please ensure you are eligible to use a scribe as per the Government of India rules governing
the recruitment of Persons with Disabilities (Refer guidelines of Ministry of Social Justice &
Empowerment).
2.0 The candidate will have to arrange his own scribe at his own cost.
3.0 The scribe can be from any academic discipline.
4.0 Both, the candidate as well as the scribe, will have to give a suitable undertaking, in the
prescribed format with passport size photograph of the scribe, confirming that the scribe fulfils
all the stipulated eligibility criteria for a scribe as mentioned above. Further, in case it later
transpires that she/he did not fulfils any of the laid-down eligibility criteria or suppressed
material facts, the candidature of the applicant will stand cancelled, irrespective of the result
of the examination.
5.0 Such candidate who uses a scribe shall be eligible for compensatory time of 20 minutes for
every hour of the examination. (Candidates who are eligible to use scribe but do not use scribe
will also be eligible for compensatory time of 20 minutes for every hour of the examination.)
6.0 The scribe shall only record the answer as suggested by the candidate and shall not import
his/her knowledge/ make any gesture / sound or movement to indicate correctness or
otherwise of any answer option.
DECLARATION
(to be handed over at the Examination Hall)
We, the undersigned, Shri / Smt / Kum. __________________________________________eligible candidate
for the ________________________________________________________________________________ examination
and Shri / Smt / Kum. ___________________________________ eligible writer (scribe) for the eligible
candidate, do hereby declare that:
1. The scribe is identified by the candidate at his/her own cost and as per own choice.
The candidate is with Blindness / Locomotor Disability (Both Arm) / Cerebral Palsy and/or
his/her writing speed is permanently affected and s/he needs a writer (scribe) as permissible
under the Government of India rules governing the recruitment of Physically Challenged
persons.
2. As per the rules, the candidate availing services of a scribe is eligible for compensatory time
of 20 minutes for every hour of the examination.
3. In view of the importance of the time element and the examination being of a competitive
nature, the candidate undertakes to fully satisfy the Medical Officer of the Organization that
there was necessity for use of a scribe.
4. We undertake to comply with the directions of the invigilator at the centre and try not to
disturb other examinees.
5. We shall abide by all the guidelines issued by NLC India Limited.
6. In view of the fact that multiple appearance / attendance in the examination are not permitted,
the candidate undertakes that he/she has not appeared / attended the examination more than
once and that the scribe arranged by him/her is not a candidate for the examination. Also,
the same scribe cannot be used by more than one candidate. If violation of the above is
detected at any stage of the process, candidature of both the candidate and the scribe will be
cancelled.
7. We hereby declare that all the above statements made by us are true and correct to the best
of our knowledge and belief. We also understand that in case it is detected at any stage of
recruitment that we do not fulfil the eligibility norms and/or that the information furnished
by us is incorrect/false or that we have suppressed any material fact(s), the candidature of
the applicant will stand cancelled, irrespective of the result of the examination. If any of these
shortcoming(s) is/are detected even after the candidate's appointment, his/her services are
liable to be terminated. In such circumstances, both signatories will be liable to criminal
prosecution.
Given under our signature: -
Signature of the Scribe Signature of the Candidate
Registration No. :
Roll No.:
Postal address: Postal address:
STD Code: ……... Phone No…………… STD Code: ……….......... Phone No..………….......
[Cell No., if any ………………………….] [Cell No., if any ………………………….]
Signature of Invigilator
Note: The candidate & scribe should report at half hour before the normal reporting time at the Exam Centre for this
purpose.