MEDICAL CERTIFICATE
COVID-19 FREE/ASYMPTOMATIC CERTIFICATE
I, Dr____________________________of ___________________________________(Name of
Government Hospital) is a registered medical practitioner and holding medical licence register number
____________have examined
Mr._____________________________S/o_______________________________on___________date
______2021 and have found Mr.______________________________free from the following diseases
CORONA VIRUS Disease-COVID-19 currently asymptomic.
Dated:
Stamp of Government Hospital
__________________________
(Signature of Doctor with Stamp)
Dr._______________________
Government Hospital
Sector________Teh_________
Dist________State__________
Pin________________
Note:- Asymptomatic certificate should have proper stamp of Government Hospital and Doctor
with registration Number of Doctor.
NO RISK CERTIFICATE
It is certified that Mr.___________________________(Name) candidate for _____________________
Recruitment Rally hereby certify that I have no COVID-19 symptoms. I fully understand that travel to
rally venue is at my own risk and I or my Parents/Guardians shall not be entitled to claim any
compensation or reconsideration for participation in the same rally or any other relief from the
Government if I am infected with COVID-19 during my transit or during my selection process in the rally.
Date: (Signature of candidate)
COUNTERSIGNED
(Signature of Parents/Guardian)
Name____________________
Address__________________
__________________
__________________
__________________
INDEMNITY BOND CUM UNDERTAKING CERTIFICATE
1. I, ________________________________Son/Brother of
No_______________Rank______________Name ____________________________attending
recruitment rally at ______________________________________________________ onwards
hereby declare that I have not used/taken any performance enhancing drugs during the
recruitment rally and I shall be liable to disqualification from the rally in case of having been
found to have done so.
2. I further certify that I will be solely held responsible in case of any mishappening during the
run/other physical test due to consumption of drugs and liable to disqualification from the
recruitment rally.
3. Recruitment agencies/Army will not be held responsible for the mishappening.
______________________________ ___________________________
(Left thumb impression of candidate) (Signature of candidate)
UNMARRIED CERTIFICATE
1. This is to state that Mr._______________________________________________ S/o
________________________________________is permanently residing at the under
mentioned address :-
Latest Passport size
Photography of the
Village - ________________________ candidate duly attested
by Village Sarpanch
PO - ________________________
with seal
PS - ________________________
Tehsil - ________________________
District - ________________________
State - ________________________
PIN - ________________________
2. I know Mr._______________________________________________________S/o
____________________________________________ very well. He bears a GOOD MORAL
CHARACTER and is UNMARRIED TILL DATE.
Place ____________ (Signature of Gram Pradhan/
Village Sarpanch/Ward Member)
Dated:
(Office seal)
CHARACTER –CUM-PRE-VERIFICATION CERTIFICATE
1. It is ceritified that Master _____________________________________son of ___________
__________________________________Caste _____________________ resident of
village________________________ PO______________________Tehsil________________
District _________________ State __________________________ whose Signature/thumb
impression is appended below, is known to me for the past ____________years.
2. To the best of my knowledge and belief :-
(a) He bears a good moral character.
(b) He has not been convicted by any civil court.
(c) He has never been imprisoned.
(d) He has not been dismissed from any Govt service.
(e) He has not been serving in the Army/Navy/Air Force/TA or Police.
3. It is further certified that he is not related to me.
___________________________ ___________________________
(Signature/Left thumb impression (Signature of the Village Sarpanch
Of the of prospective recruit) Sarpanch/Pradhan with Office seal)
AFFIDAVIT SPECIMEN SHOULD BE ON RS 10/- NON JUDICIAL STAMP PAPER
1. I, ___________________________, Son/brother of No.________________ Rank ____________
Name ____________________________ residing at Vill ________________ PO _____________
Tehsil __________ police station ____________ District ______________ State _____________
Do hereby solemnly affirm and declare as under:
(a) That I am citizen of India.
(b) That I am residing at the above mentioned address.
(c) That I am UNMARRIED till date.
(d) That all my documents produced the recruitment rally _____________ held at
____________________ are correct and genuine in case my documents are found false/
deficient, I will be blamed and responsible for that.
(e) That if any information relating to my documents is not correct. I am responsible to inform
this matter during my submission of documents.
(f) That if any information on submission of documents including the statement in the affidavit
is found to be false or incomplete now or at any stage. I am liable for prosecution under the
relevant law and my service will be terminated despite of any No. of years service.
(g) That it is true statement.
Attested
Dated: (Signature of candidate)
Date: Signature of Executive Magistrate
(Office seal) class-1/SDM/Tehsildar/Notary
with rubber stamp
Joint photo of both
AFFIDAVIT and attested by
father
1. I, No _____________ Rank ____________
Name _________________________ of
(Unit)_______________hereby declare that
(Candidates Name) _________________ S/o (fathers Name) ______________________
(Mothers Name) __________________________(In case brother of) whose photograph is
affixed above is my son/ real brother.
2. Date of Birth of (Candidates Name) ____________________________ is ________________
as per the Birth Certificate No.______________________ issued by ___________________
(Issuing Authority) and as recorded in the Matriculation Certificate
No.___________________ issued by ______________________ Education Board.
3. I undertake that I am liable to be punished under Army Act if the declaration make by me at
paragraphs 1 and 2 above are found to be incorrect / false at any stage.
Date: ____________________________________
(Signature of Serving soldier/ Ex-serviceman)
Army No:
Rank :
Name :
Unit :
Date: Signature of Executive Magistrate
Class-1/SDM/Tehsildar/Notary
with rubber stamp (Office Seal)
Attested
passport size
photograph of
AFFIDAVIT
candidate
It is certified that I, Master ______________________________________
S/o ________________________________ Mother Name ________________________ resident of
Vill ______________________ PO ________________________ Police station ____________________
Teh _________________ Dist _____________ State _________________________ PIN
__________________ Caste _________________ Sub caste ______________ Religion ____________
DOB _____________ had or have not been a member of any banned / political organization and have
never been in custody / jail and no criminal or Judicial case is pending against me in any court of law in
India/ abroad. That I have not been ever convicted for any offence under the law.
(Signature of Candidate)
COUNTERSIGNED
Place: ____________ Signature of
Executive Magistrate/
Date: Sub Divisional Magistrate
(Office Seal)